First Name* Last Name* Address 1* Address 2* City* State* Zip / Post Code* Email* Daytime Phone*FaxHosting Group Name (if applicable) Hosting Group Twitter Handle Hosting Group Facebook Page Are 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 Begins Event Ends* Event Information Phone Event Information Email Event Website Where are you hosting your event?*Please describe your event, be as thorough as possible.*Will you have a ticket price or entrance fee?* Yes No If 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?* Yes No If 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?* Yes No If 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?* Yes No I 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.
