Event and Donation
Online Application

Name:

501-C(3) #:

Address:

City, State Zip:

Website:

Email:

Mission Statement:

Coordinating Contact
and Phone #:

Check one:

Event Participation
Donation
Sponsorship

Name of Event:

Date of Event:

Type of Event:

Goal of Event (description):

Set Up Time:

Tear Down Time:

Hours of Event:

Expected Attendance:

Previous Years Attendance:

Did we participate in
previous events:

Yes No

Who was your contact person:

What type of event participation is being requested:

Booth Speaker

What type of donation items are you requesting:

Food Gift Cards
Gift Baskets (include whole products)
Vitamins & Supplements
Will a knowledgeable person be distributing vitamins and/or supplement products?
Yes No
Other:

Donation will be used for:

Prize

Auction

H.O.P.E.
(Humanitarian Outreach Program Efforts - requests for recipients to receive our damaged, expired and returned usable products)

Who do we contact to pick up donations? Name and phone: