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MBCN Application for a Third Party Fundraiser

Before completing this application, you are required to read
MBCN Policies and Procedures for a Third Party Fundraiser.

First Name Last Name

Address

City State Zip

Phone Fax Email

Event/Promotion Title

Target Audience

Event/Promotion Date Hours Location

Describe the event

Do you plan on charging admission Yes No

Do you have items for purchases? Yes No

Please specify

Expected Number of Attendees Expected Total Donation Amount $

Other Sources of Donation

Potential Sponsors or Underwriters

What is your personal motivation for planning an event?

How do you intend to publicize and/or promote this fundraiser?

After you submit this form you will be contacted by MBCN for approval or suggested modifications.

I have read MBCN Policies and Procedures for a Third Party Fundraiser and agree to abide by them Yes