Organization/Charity Name:

Name of Event:

Contact Name:

Contact Email:

Contact Phone:

Website:

Short description of event (ie Fundraiser, Silent Auction, Tournament, etc):

Today's Date:

Event Date:

Do you require a response by a certain date?

YesNo

If yes by when:

When is the donation needed?

Is there a donation preference type? (ie giftcard,merchandise, etc):

Event Location:

Estimated number of attendees:

Any other information (event details, attendee demographic, etc):

Are you expecting any media coverage or sponsorship?

YesNo

If yes, please list below (radio, television, print, web)