Event Request Form

Please complete the Event Request Form. A Third Party Event is any fundraising activity conducted where The ALS Association has no fiduciary responsibilities and little or no staff involvement. The ALS Association requires that all third party organizers submit a completed Event Request Form before initiating any activity.
Once the request is approved we will contact you. A Third Party Agreement will clearly define roles and expectations to help ensure a satisfying experience.

Event Name

Group Name

Company Name

First Name

Last Name

Street Address

City

State

Zip Code

Phone

Select Month of Event

Date

Year

Describe Your Event:

This event is

Open to the PublicInvitation Only

Ticket Price - if applicable: (please enter a whole number without a dollar sign)

Table Price - if applicable: (please enter a whole number without a dollar sign)

Value of Goods and Services per ticket: (Approximate actual value in dollars that participant will receive, which is not tax- deductible)

Is this a first time event?

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If yes, what role would they play?

How will the event be publicized?

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Please check all the items/support you will require from The ALS Association Florida Chapter.

List all businesses you intend to solicit for sponsorship or in-kind contributions:

Budget/Fundraising Information:

Gross (Total) Projected Revenue:

Total Projected Expenses:

Do you intend to share the net proceeds with another organization?

Please note that selecting 'yes' will create additional requirements in order for The ALS Association Florida Chapter to approve and participate in this event.

If yes, please identify the additional beneficiary:

If yes, is this beneficiary a 501(c)(3) organization?