FUNDRAISER APPLICATION

Please complete the entire form. If you have any questions, please email info@bromemoderneatery.com.

Fields marked with an * are required.

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EVENT DATE & TIMES
Event Date *of appointment
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Start Time *
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End Time *
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ORGANIZATION INFORMATION
Name of your group or organization *
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Tell us about your group or organization *more details
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Tax ID (if applicable)
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Contact Name *
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Phone Number
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Who should we make the cheque payable to? *
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SIGN & DATE

By signing below you acknowledge and agree to our terms and conditions for fundraising programs.

Your Signature (type your full name) *
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Date *
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