Community Fundraising Application Community Fundraising Application Proposed Event Organizer(s) InformationName of organization/company or individual(s) planning the event:* Primary contact name* First Last Primary contact email* Enter Email Confirm Email Primary contact phone*Primary contact address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Have you ever worked with NEADS before? Yes No If yes, please describe your relationship with us:If no, how did you hear about us?Proposed Event InformationName and description (type and details) of event/activity:* Proposed event date (option 1):* MM slash DD slash YYYY Proposed event date (option 2) MM slash DD slash YYYY Event start time : Hours Minutes AM PM AM/PM Event end time : Hours Minutes AM PM AM/PM Event location: Event location Address City State / Province / Region ZIP / Postal Code Please indicate if this is a new or recurring event: New Recurring Is this event open to the public? Yes No How else will funds be raised? (i.e., ticket sales, silent auction, donations)Does this event require permit or insurance? Estimated amount that will be donated to NEADS: Are any other organizations being named beneficiary of this event? Yes No If yes, please name the organization(s):% to each organization: What program would you like your donation to support? Community Fundraising donations are devoted to General Funds to support all programs as needed unless otherwise noted:Comments:
