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Today’s Date_______________________________
Name of Event
___________________________________________________________________________
Event
Date(s)___________________________________________ Event
Time(s)_____________________
Your Organization/Company Name
___________________________________________________________
Contact Person &
Title______________________________________________________________________
Phone ____________________________ Fax
__________________________
e-mail ______________________
Street/City/State/ZIP
______________________________________________________________________
Description of
Event_________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
For more information, people should
contact:______________________________________________________________
Who is the target
audience?____________________________________________________________________________
Will you need a Gilda’s Club Madison
representative at the event? ________If so, what
time?_________________________
Will you need Gilda’s Club Madison volunteers
to help staff the event?_____________. If so, how
many?_______________
Do you plan to use Gilda’s Club name/logo to
promote event? _________
(Please note: any use of Gilda’s Club Madison’s
name in printed materials must be pre-approved by Gilda’s Club
Madison. See our Third Party
Guidelines for more information.)
How can Gilda’s Club Madison Wisconsin help
meet your expectations for the event? _______________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Will any other charitable organizations
benefit from this event? _______
If yes, please list other organization(s) and
percent of proceeds each will receive:
___________________________________
__________________________________________________________________________________________________
Expected proceeds from the event?
______________ What percent of the proceeds will Gilda’s Club
receive?____________
Check to be mailed?____ Picked up?_____
Expected Date?_______________
Signature of Contact
Person/Organization_____________________________________
Date________________________
For
office use
For GCMW
Event Coordinator
o Add to GCMW Calendar of
Events o Donation received
on ____________
o Assign Event Project Manager, if needed
o Add to GCMW website
o Donation recorded on ____________
o Initial acknowledgement sent__________
o Add to GCMW newsletter
o Thank you/501(c)(3) letter sent________ o
Follow up, as needed_________
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Approved by GCMW
_____________________________________________________
Date________________________
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