First Name*Last Name*Address 1*Address 2*City*State*Zip / Post Code*Email* Daytime Phone*FaxHosting Group Name (if applicable)Hosting Group Twitter HandleHosting Group Facebook PageAre you a*Civic OrganizationCorporation/BusinessIndividualReligious GroupSchoolNon-ProfitIs this event*Public (SAFE may post on website and Facebook)Private (by host invitation only - not to be publicized)Date of Event*Event BeginsEvent Ends*Event Information PhoneEvent Information EmailEvent WebsiteWhere are you hosting your event?*Please describe your event, be as thorough as possible.*Will you have a ticket price or entrance fee?*YesNoIf yes, please include price information.If hosting an in-kind fundraiser, what items do you plan to collect?Diapers, toiletries, cell phones, etc.How will this event benefit SAFE?Example: 10% of ticket sales will be donated to SAFE.Will there be entertainment? Please be as specific as possible.*Please list other organizations that will also benefit from this event.Will businesses be contacted for donation for your event?*YesNoIf yes, please list prospects for us to review to avoid duplicated efforts with businesses we may have already approached.Do you wish to use SAFE's name, logo or program/service information to help promote your event?*YesNoIf yes, what types of promotion do you plan to use? Brochures Flyers Posters Radio Ads TV Spots Viral Marketing Please check all that apply.Would you like a link sent containing various materials to print?*YesNoI have read, understand and agree to the guidelines posted for hosting a fundraiser to benefit SAFE.*Please type name in lieu of signature.EmailThis field is for validation purposes and should be left unchanged.