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, please name the other beneficiaries and describe extent: Please confirm that approval has been received from other beneficiaries

BackStoppers representative/speaker

Name *

First

Last

Organization/Company:

Street Address:

Phone: *

Email: *

I have read and agree to the terms below.

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.

Choice 1

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.

Choice 1

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.

Choice 1

Applicant agrees that fundraiser proceeds must be submitted to The BackStoppers® donation address within 60 days of the conclusion of the fundraiser. (In the case of an ongoing promotion, a proceeds submission schedule is agreed upon by BackStoppers® and the organizer.)

Choice 1

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.

Choice 1

Applicant is aware and agrees that fundraiser proceeds must be sent directly to BackStoppers, Inc. unless otherwise discussed and approved.