Organization Information

Name of Organization *

Organization City *

Organization State *

Contact Person (First Name) *

Contact Person (Last Name) *

Phone Number *

Contact Email *

Are you a Charitable Organization? *
YesNo

Event Information

Date of Event ( 00/00/0000) *

Name of Event *

What type of event will you be hosting? (Silent or live auction, raffle, etc.) *

What kind of attendance do you anticipate for your event? *

Who will these proceeds benefit? *

Additional Comments (optional)

Please include a wish list of your top 3 requests for donation. (Cash, trade, product, other) *

1.

2.

3.

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