Fundraiser Application

Organization Name*

Name of Parent Organization (if different)

Street address*

City*

State*

Postal code*

Contact First Name*

Contact Last Name*

Contact Phone Number*

Contact Email Address*

Check payable to:

Company name*

Street address*

Street address 2

City*

State/Region*

Postal code*

Proposed Date(s) of Fundraiser*

Expected Attendance*

Notes