Community Fundraiser Application Title of event* Name of individual planning event* Name of organization planning event* Type of organization* Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Daytime phone Name of event* Date & time of event* Location of event* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Event is* Open to the public Invitation only Ticket price $* Will alcohol be served?* Yes No Bar* Open Bar Cash Bar Liquor license obtained?* Yes No Is the event wheelchair accessible?* Yes No Has this event been held before?* Yes No If yes, when? (date) Charity Recipient $ Amount Raised Will you be asking for donations from businesses or organizations?* Yes No If yes, please attach a list. Please use the amount raised to support the following program: Assistance Dogs for Achieving Independence (ADAI) Equipment Loan Home Accessibility Life Skills Please describe the event and its fundraising components (ticket sales, sponsors, auction, entertainment, etc.) and purpose for doing the event: Would you like a representative from The Ability Center to speak at your event? Yes No If yes, please send a copy to The Ability Center Will The Ability Center be the only beneficiary of proceeds from your event? Yes No If no, please attach a list of additional beneficiaries. Please share with us why you chose to support The Ability Center. I have read and agree to follow the enclosed guidelines for my event benefiting The Ability Center. Signature* Date* Date Format: MM slash DD slash YYYY Print Name First Name Last Name Print Title (if organization) You will be n otified of approval within 10 business days. Thank you for your interest in helping support our mission. We can’t wait to work with you! Comments This field is for validation purposes and should be left unchanged.
