Special Events and Promotions Online Application

Name of Event or Promotion*
Dates*
Location*
Briefly Describe Event or Promotion*
Contact*
Title*
Business*
Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Email*
Phone*
Other Beneficiaries of this Event*
- Yes
- No
Please Provide the Name(s) of Organization(s)*
Have you ever coordinated this type of event or promotion before?*
- Yes
- No
Previous experience description*
How will funds be raised (ticket sales, pledges, sponsorship, percentage of proceeds, etc.)?*
What participation or resources do you request from the Foundation?*
Do you plan on using the Foundation name or logo?*
- Yes
- No
Please explain how (you must receive the Foundation’s approval in advance.)*
Anticipated audience*
Revenue estimate (individual/organization not liable for amount listed)*
Gross proceeds*
Expenses*
Estimated donation*
Estimated items sold*
Estimated donation date*
MM slash DD slash YYYY
I have read, understand and agree to abide by the preceding guidelines for events and promotions to benefit the Dave Thomas Foundation for Adoption.*
- I have read, understand and agree to abide by the preceding guidelines for events and promotions to benefit the Dave Thomas Foundation for Adoption.*
Signature*
Date*
MM slash DD slash YYYY

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