EmailMe Form - Special Event Proposal Form

Name of event *

Nature of event (please provide detail) *

Has this event occured in the past? *

Yes

No

If yes, when?

Location of event *

Date/time of event *

MM / DD / YYYY HH : MM AM/PM

Rain date

MM / DD / YYYY

Indoor/Outdoor? *

Indoor

Outdoor

Projected attendance *

Will any other charitable organization benefit from this event? If so, name the organization and include extent of their participation and benefit they will receive. *

Will you need assistance from our staff/volunteers in order to make this event successful? If "yes," please describe: *

Name of sponsoring organization or individual (include contact name) *

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Relationship to Transitions LifeCare (if any)

Transitions LifeCare accepts no legal or financial responsibilities for events held on our behalf. Do you have comprehensive liability insurance? *

Yes

No

Transitions LifeCare reserves the right to review all materials which include our name, logo, and description of our services. Please select the types of promotional activity you are planning (press cntl key to make more than one selection).

Estimated gross receipts *

$ Dollars . Cents

Estimated expenses (including all rentals, printing, advertising/promotion, entertainment, decorations, etc.) *

$ Dollars . Cents

Estimated amount Transitions LifeCare should receive *

$ Dollars . Cents

When will proceeds be distributed? *

MM / DD / YYYY

I certify that the answers given herein are true and complete to the best of my knowledge (type name and date in box). *