Third Party Form

Please fill out the form below with as much information as possible.

If you have any questions or concerns, please email the Fundraising and Events Coordinator: Victoria@LupusGreaterOhio.org, or reach out to the office by calling (440) 717-0183.
Event Name
Contact *

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com
Describe the Company Affiliated with This Event
Thank you for wanting to support the LFA, GOC! Please share your connection to lupus.
Event Vision
Expected Attendance
Staffing Needs
Event Date

MonthDayYear
Have You Booked the Venue for this Date?

YesYes, but it can be changedNo, it is flexibleNo, but it is preferredOther
Alternative Date

MonthDayYear
Address of the Event

Street Address

Street Address Line 2

CityState

Zip Code
Marketing Plans
Chapter Expectations
Donor/Sponsor Info
Will the Chapter Receive 100% of Event Proceeds?

YesI don't know yetNoOther
Please Explain:
Will You Require Donation Receipts?

YesI don't know yetNoOther
The Chapter will issue receipts for tax-deductable donations pursuant to IRS regulations.
Will Alcohol Be Served at the Event? (Legal Requirements Apply)

YesNoOther (Please Explain)
If there will be GAMING at your event, a gaming license is required by law. Please indicate if you intend to have any of the following at your event:

BingoRaffle50/50 Draw (Split the Pot)Other (Please Explain)
How Will Funds Be Raised?

TicketsPledgesSilent AuctionProduct SalesDonationsLive AuctionOther (Please Explain)
Answer Financial Information Based on Your Best Estimate

Expenses: Income:

$
Expected Profit
If you have any questions or concerns, please email the Fundraising and Events Coordinator: Victoria@LupusGreaterOhio.org, or reach out to the office by calling (440) 717-0183.
I, First Name* Last Name*, am submitting this application to share my desire to organize a third-party event that will benefit the Lupus Foundation of America, Greater Ohio Chapter (LFA, GOC) referred to as "the Chapter" within this online form. I certify that I am submitting this document as the "Organizer" or authorized representative of the "Organizer" as described in the terms and conditions of this application. I understand that submission of this form does not grant permission to host an event using the Chapter logo or the LFA, GOC name. I acknowledge that a representative will contact me to finalize or reject this agreement.
Should be Empty:

	Expenses:	Income:
$

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