Community Fundraiser Application

Contact Name*

First

Last

Title of event or fundraiser*

Contact Person Email*

Name of organization planning event

Address*

Street Address

City

State

ZIP Code

Event is

Ticket price $

If an event, is the event location wheelchair accessible?

Has this event/fundraiser been held before?*

If yes, when? (date)

Will you be asking for donations from businesses or organizations?*

If yes, please attach a list.

How would you like the money be used?*

Please briefly describe the event/fundraiser*

Will The Ability Center be the only beneficiary of proceeds from your event?*

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*

First Name

Last Name

Date*

Phone

This field is for validation purposes and should be left unchanged.