Third Party Event Form Event Information Name of Event Location of Event Date of Event Time of Event Contact Information First Name Last Name Email Phone Number Street Address City State Zip Code Preferred method of contactEmailPhoneText Allocation of Funds for this Event Walk Team - funds are applied to your area walk team Enter percentage Area of Greatest Need - the area of our chapter with the greatest need for funding at this time Enter percentage Care Services - funds to help support our free programs and services to individuals and families in Wisconsin living with ALS Enter percentage Brian Trinastic Grant Fund - help defray the costs associated with transportation and lodging for treatment and events, medical equipment and home modification for members Enter percentage Equipment Loan Program - funds for inventory of wheelchairs, scooters, walkers and other equipment loaned free of charge Enter percentage Augmented Communication Devices - support providing speech-generating devices to improve the quality of life for patients who have lost their speech Enter percentage Research - funds to support finding treatments and a cure for ALS Enter percentage Event Details Event Activities & Description Example: Bowling event to "Strike Out ALS", we'll feature prizes for first, second, and third place with dinner and a live band after we roll. How will the event raise money? (check all that apply)Registration Fees SponsorshipsRaffle (only selling tickets day of event)Raffle (selling tickets before event and day of event)Auction How will the event be promoted? (check all that apply)Social MediaPostersEmail CampaignDirect Mail What is your fundraising goal for this event? Do you want an online donation & registration page?YesNo reCAPTCHA helps prevent automated form spam. The submit button will be disabled until you complete the CAPTCHA. Contact Information
