Event Date:                                                           Time:
       

Event Location:

Organization:

Charitable Organization Registration # (if applicable): 

Type:
Corporation
School
Team
Charity

Event Description:

Event Sponsors (If applicable):

Event Partners (If applicable):

Projected Attendance:         Age Range:

Date of Request (Today's date):

What are you requesting?

Contact Name:                                                      Title:
       

Email Address:                                                      Tel:
       

Address:

City:                                          Province:                                    Postal Code
                  

For Office Use Only

Donation:   Value ($):

Pick-Up/Delivery: