Third-Party Fundraiser Application - The BackStoppers, Inc.

Submit Fundraiser for Approval

Please include as many details of the event, fundraiser, or promotion as possible. Thank you for your interest in supporting our mission!

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:

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.

Name