Organization
or Company Name*
First
Name*
Last
Name*
Your
Title*
Select
Activities
Director
Administrator
Advisor
Band
Director
Board
Member
Chairperson
Co-Chairperson
Coach/Athletic
Director
Director
Executive
Director
Manager
Member
Owner
PTA/PTO
President
President
Principal
Scout/Cub
Master
Secretary
Sponsor
Teacher
Treasurer
Vice
President
Vice
Principal
Youth
Director/Leader
Other
Address
1*
Address
2
City*
State*
Zip*
-
AB
AK
AL
AR
AZ
BC
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MI
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MO
MS
MT
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NC
ND
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NF
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NT
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OK
ON
OR
PA
PE
PR
QC
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SD
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TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
Country*
Select
United States
Canada
Other
If
other specify
E-mail
Address*
Daytime
Phone*
Best
Time To Call* (Time is based on Central
Time Zone)
Select
8
a.m. - 12 p.m.
12
p.m. - 5 p.m.
5 p.m.
- 8 p.m.
8
p.m. - 11 p.m.
8
Am to 12 Midnight
Group
Type*
Select
from list below
Schools
- College/University
Schools
- Elementary
Schools
- High
Schools
- K-12
Schools
- K-8
Schools
- Middle
Schools
- Special
Schools
- Vocational/Tech
Youth
Grps/Orgs - Arts
Youth
Grps/Orgs - Civic
Youth
Grps/Orgs - Hobbies/Special Interests
Youth
Grps/Orgs - Other
Youth
Grps/Orgs - Pre-school/Day Care
Youth
Grps/Orgs - Religious
Youth
Grps/Orgs - Scouts
Youth
Grps/Orgs - Sports
Adult
Grps/Orgs - Arts
Adult
Grps/Orgs - Civic/Fraternal
Adult
Grps/Orgs - Health/Disease
Adult
Grps/Orgs - Hobbies/Special Interests
Adult
Grps/Orgs - Other
Adult
Grps/Orgs - Professional Assoc.
Adult
Grps/Orgs - Religious
Adult
Grps/Orgs - School Support
Adult
Grps/Orgs - Sports
Corps
- Corp Empl Benefit
Corps
- Corp Fund Raiser
Corps
- Credit Union
Retail
- Kiosk
Retail
- Natl Bkstore
Retail
- Retail
Retail
- Retail1
Retail
- Retail2
Retail
- Retail3
Other
Do
you fundraise currently?*
Yes
No
How
much do you raise annually?*
Select
N/A
$0 - $500
$501 -
$1,000
$1,001
- $2,000
$2,001
- $5,000
$5,001
- $7,500
$7,501
- $10,000
$10,001
- $15,000
$15,001
and more
No.
of members in your group?*
Select
0 to 5
6 to 10
11 to 25
26 to 50
51 to 100
101 to 250
251 to 500
501 to 750
751 to
1000
1000 and
over
How
many people will be fundraising?*
Select
0 to 5
6 to 10
11 to 25
26 to 50
51 to 100
101 to
250
251 to
500
501 to 750
751 to
1000
1000 and
over
How
much money do you expect to raise?*
Select
$0 - $500
$501 -
$1,000
$1,001
- $2,000
$2,001
- $5,000
$5,001
- $7,500
$7,501
- $10,000
$10,001
- $15,000
$15,001
and more
When
would you like to begin?*
What is the date
and time of the event or range of dates for the
promotion?
Select
January
February
March
April
May
June
July
August
September
October
November
December
What
will you do with the funds?*
Select
Contribute
to General Fund
Funds
for a Specific Need
Group
cause/Charity
Unknown
at this time
Do
you expect this event to be an ongoing, annual
or one-time event?
Yes
No
How
will the event or promotion be advertised and
how will it include the Beyond Your Imagination,
( Dr. H ) name?
List
specific media outlets if applicable (TV, radio
and newspaper) and when press releases would be
released.
When
and where will promotion occur?
Explain
how participants or donors will receive gift
acknowledgements and or thank you's:
Have
you secured a place to hold the fundraiser?
Yes
No
If yes, how many people can it
hold.
Select
75
100
101 to 250
251 to 500
501 to 750
751 to
1000
1001 to
2500
2501 and
over