Benefit Approval Form

Benefit Approval Form

Please complete all areas that are appropriate to your event
Name

First NameLast Name
Company/Organization (If any)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Fax
Please enter a valid fax number.Format: (000) 000-0000.
Email
example@example.com

Donation Information
Will there be a financial donation made to Childhood Cancer Foundation of Southern California?
Please explain the Donation to be received:
Is the donation in relation to an event? Is it part of a Grant?
Please provide an estimate of the financial contribution to be made

The undersigned represents and warrants that he/she has submitted the Benefit Approval Form and is fully authorized to enter into this Agreement and agrees to be bound by all of the terms and conditions set forth in the Community Fundraising Event Guidelines when conducting fundraising activities/events to benefit Childhood Cancer Foundation of Southern California, Inc. (CCFSC).
Name

First NameLast Name
Signature
Date signed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

ACTIVITY/EVENT DETAILS