Partnership Interest Form Organization/Practice Name Primary Contact Name Title/Role Phone Number Email Address Website Business Address Total Number of People in Housould Orthodontic Provider Financial Sponsor Corporate Sponsor Community Partner Event Sponsor In-Kind Donation Provider Other: If you are an orthodontic provider, please complete the following I am a licensed orthodontist in good standing. License Number I am interested in: Accepting foundation-approved patients Offering discounted treatment rates Providing flexible payment arrangements Sponsoring a child annually Other: Estimated number of patients you could support annually If you are a sponsor or business partner select your interests Annual Sponsorship Sponsoring a specific child Matching Gift Program Event Sponsorship Recurring Donations In-Kind Support Other: Estimated annual contribution (optional) Please briefly share why you are interested in partnering with Smiling BIG Foundation, Inc. I understand this form is an expression of interest and does not create a binding agreement. I consent to being contacted regarding partnership opportunities. Signature Date Send
