Special Event Application

Required Event Information

Part 1: Contact Information

First Name Last Name Are you an Company or Organization Name (if applicable) Name as you would like to be recognized (Do you want the event name, organization name, individual name, etc.?) Street Address City State Phone Number Fax Number Email Address

Part 2: Event/Promotion Information

Website Name of Proposed Event or Promotion Proposed Date(s) Event Description

Are there any other beneficiaries of this event or promotion? Yes No

If yes, name of other organization(s) Location of Proposed Event or Promotion Projected Attendance Are you fundraising for a special area or the area of greatest need? The fund or program that you select must currently exist. For funds or programs not listed below, please select “other” and specify in the comment box below. Other fund or program not listed in the dropdown menu: Briefly explain how funds will be raised (ticket sales, pledges, sponsorships, auction, etc.)

Does the event require a license or permit? Yes No

What is your plan for publicity and promotion? Press Releases Promotional Flyers Public Service Announcements Internet Presence Other

Please list the anticipated recipients of the above publicity and promotion plan List businesses, other than your own, that you plan to solicit for donations (cash, service or items)

Part 3: Financial Information

Remember to limit expenses to no more than 50% of gross proceeds. All donations must be made within 30 days of completion of the even or promotion.

Anticipated Total Revenue Anticipated Total Expenses (Please estimate the individual expenses for the items below) Food/Beverage Printing Security Advertising/PR License/Permit Fee Prizes Supplies Other Anticipated Total Donation

Does your company plan to match the amount you raise? Yes No

How will you transmit your donation to Nationwide Children's Hospital? I have read understand agree to abide

If you click "Submit" and do not receive the confirmation screen, please scroll to the top of the form to see which fields need updated. Your form has been successfully submitted when you receive the confirmation screen. Thank you!

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Required Event Information

Part 1: Contact Information

Part 2: Event/Promotion Information

Part 3: Financial Information