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ICIA Fundraising Event Form
Please complete this form at least
30 days
prior to the event &
60 days
prior to a State Functions Event. All questions containing a "*" must be completed.
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* Indicates required question
Name of Person Completing Form:
*
Your answer
Email of Person Completing Form
*
Your answer
Date of the Event:
*
MM
/
DD
/
YYYY
Time of the Event:
*
Time
:
AM
PM
Event Location:
*
Your answer
Contact at Event Location:
*
Your answer
Host Name(s):
*
Your answer
Host(s) Stage Name(s):
*
Your answer
Name of Event:
*
Your answer
Theme:
Your answer
Emcee(s) or BINGO Caller (Be sure to confirm before submitting):
*
Your answer
Special Guests:
Your answer
Charity (Choose ALL that apply):
*
CAAP
NAMI
One Iowa
DSM Refugee
Guardian Angel Scholarship
Yazmine DeMornay Scholarship
Mother Earth Scholarship
Other
Required
If you chose "Other" as a charity, please list charity here:
Your answer
Immediate Dispersal of Funds?
*
Yes
No
Date of Dispersal of Funds if not immediate:
MM
/
DD
/
YYYY
Money Counters:
*
Your answer
Board Members Attending:
Your answer
Other Information:
Your answer
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