DGF CORPORATE PARTNERSHIPS THE DOCTORS GOODWILL FOUNDATION presents "A Healthy Day At Space Coast Stadium" DoctorsFoundaton.org Ph: 321‐735‐6492 Fx: 321‐633‐8374 SPONSOR COMMITMENT FORM DEADLINE IS MARCH 20, 2015 Company Name: ____________________________ Contact Person: _____________________________ Address: ___________________________________ City: ______________ State: _____ Zip: ________ Phone: ______________ Cell: ________________ Fax: _____________________________________ Email: ___________________________________ Name of DGF Host Committee Representative (if applicable) ______________________________ Sponsorship Category::_______________________ _________________________________________ Sponsorship Amount:$_______________________ Payment Method: [ ] Please send me an invoice [ ] Request sent to company [ ] Enclosed is my check for $ [ ] Please contact me to make payment by credit card Payments— Please make checks payable to Doctor’s Goodwill Foundation. Tax ID# 200716768 Please mail payments to: Doctors Goodwill Foundation P.O Box 909, Titusville, Fl 32781 Ashish Udeshi, M.D President 321-784-8211 [email protected] Sumant Pandya, M.D. Immediate Past President 321‐636‐2211 Ext 1349 [email protected] Kiran Modi, M.D. Treasurer 321‐264‐9100 [email protected] Naren Shah, M.S. SCORE Executive Director 321‐773‐0050 [email protected] Denis Perez M.D. Secretary 321‐383‐2122 [email protected] Kantilal Bhalani M.D. Founder 321‐298‐5331 [email protected] DGF EXECUTIVE OFFICERS Featuring Medical Spelling Bee • Healthy Living Lecture Series • Health Fair • CME Professional Baseball with the Brevard Manatees vs. Blue Jays • Fireworks SATURDAY , APRIL 18, 2015 SPACE COAST STADIUM • VIERA To benefit charities supported by e Doctors Goodwill Foundation e Doctors Goodwill Foundation in cooperation with e Brevard County Manatees, Space Coast Medicine Magazine and Space Coast Daily will present a fun, educational and healthy day for the entire family and medical community at Space Coast Stadium in Viera, on Saturday, April 18, 2015. is fun day for the whole family will include: • e Dwight E. Jones Medical Terminology Spelling Bee for students in grades 5-12 from 9 am - 12 pm. Free admission. • Expert speakers presenting free seminars with the latest information on a variety of health topics from 1 pm - 4 pm. Free admission. • A Health Fair with over 100 exhibitors showcasing the latest and best in products and services to help maintain best health. Pick up great info and tips on best health practices and fill your grab bag full of useful and fun giveaways from 5 pm - 9 pm. • A Continuing Medical Education Event (CME) for physicians, nurses, ARNP's and other medical personnel to earn important credits for their professional field. e CME event will begin at 4:30-8:30pm, so your family and friends can enjoy the baseball game and you can join after you earn those CME credits. Associaton of American Physicians Inc Brevard County Health Department Brevard County Pharmacy Associaton Brevard Physicians Network Brevard Medical Society Central Florida Physicians of Indian Origin Health First System Hospice of St Francis Parrish Medical Center Space Coast Cancer Center The Doctors Company VITAS Hospice Walgreens Wuesthoff Medical Center Media Partner Space Coast Medicine & Actve Living Magazine Brevard Business News Space Coast Daily Savings Safari