* required information
Community Fundraiser Application 
Applicant Information
Name of Individual/Group:*
Primary Constituent Type:*
Organization Name:
First Name:*
Last Name:*
Address Line 1:*
Address Line 2:
City:*
State:*
ZIP/Postal Code:*
Phone:*
Cell Phone:*
Email:*
Name of Fundraiser:*
Date(s) of Fundraiser:*
Time(s):*
Location:*
Is this in support of a MDSC Buddy Walk?:*
If so, which Buddy Walk?:
Team Name:
Type of Fundraiser (i.e. Coin drive, golf, gala, etc.):*
Are you using an (e)asy fundraising kit?:*
If so, which kit?:
Details of Fundraiser:*
Ticket Price:
How Will You Promote:*
Is the MDSC the only Beneficiary?:*
If no, who?:
What percentage of net proceeds will go to the MDSC?:*
Estimated Revenue $:*
Estimated Expenses $:*
Estimated Proceeds $:*
When will MDSC receive the funds? (must be sent within 30 days):*
Initials:*
Fees
$0.00 Community Fundraisers Application
Initialing above verifies that I have read the Community Fundraising Guidelines and understand that all community fundraisers to benefit the MDSC must be approved prior to any activity. The MDSC reserves the right to request any additional information prior to approving a community fundraiser. A MDSC staff member will contact you within 7 days of this application being received.