Special Events and Promotions Online Application – Dave Thomas Foundation for Adoption

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*

Please Provide the Name(s) of Organization(s)*

Have you ever coordinated this type of event or promotion before?*

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?*

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*

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*