Third-Party Fundraiser Application - The BackStoppers, Inc.

Fundraiser Date *

Fundraiser Title *

Fundraiser Organizer *

Start Time *

End Time *

Fundraiser Location/Address *

Fundraiser Description *

*Please describe in detail the proposed fundraiser and all additional features. Please note, unlimited alcohol and an open bar cannot be approved.

How are funds raised for BackStoppers? *

registration, admission, food sales, % of proceeds, etc.

Is BackStoppers the sole beneficiary of this fundraiser? *

If no, name the other beneficiaries and describe extent: Please confirm that approval has been received from other beneficiaries

Are proceeds being sent directly to BackStoppers, Inc. or an approved entity that benefits BackStoppers? *

Yes, proceeds are being sent directly to BackStoppers, Inc. (EIN: 43-6032561)
No, proceeds are being sent to one of an approved entity that benefits BackStoppers. (See list of approved entities in Fundraiser Guidelines)

If no, name the approved entity provided in the list in the Fundriaser Guidelines *

BackStoppers representative/speaker

Your Name *

First

Last

Organization/Company:

Street Address:

Email *

Phone Number

Review and Agree: Insurance and Liability *

Applicant understands that BackStoppers is not an organizer of the event and is not liable. Applicant understands that BackStoppers does not provide insurance. Applicant accepts all responsibility and liability in the event of an incident. Applicant accepts responsibility on insuring the event and complying with the event venues' insurance policies.

Review and Agree: Fundraiser Proceeds *

Applicant agrees that fundraiser proceeds must be sent to BackStoppers within 60 days of the conclusion of th event. Applicant agrees that fundraiser proceeds that are being sent to another approved entity benefiting BackStoppers must submit proof of the donation within 60 days of the conclusion of the event.

Applicant has read the Third-Party Fundraiser Guidelines Benefitting The BackStoppers® and agrees to abide by them. Applicant understands that approval must be granted by The BackStoppers® Events Manager before Applicant can plan or promote the proposed fundraiser. BackStoppers® is not liable to any vendor or other third-party for any fees, costs, or payments of any kind associated with the fundraiser. Applicant has agreed to comply with all relevant local, state and federal law including obtaining required insurance, permits or licenses and to present, where applicable, proof of necessary insurance and participant waiver. Applicant is aware and agrees that they are responsible for expenses incurred and maintaining accounting of the fundraiser, and The BackStoppers® will not be liable for any costs or expenses. Applicant is aware and agrees that BackStoppers® must review and approve all publicity material related to the fundraiser and anything on which our name and/or logo appear before it is printed or distributed, and must comply with the Marketing and Promotion Guidelines.