Fri 30 Jan, 2009
FUND RAISING ACTIVITY APPROVAL FORM
TO: Potentate,___________________ Shriners AAONMS
RE: Seeking Approval to Conduct a Shrine Fund Raiser
We respectfully request permission to hold the following fund raising activity.
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Fraternal Purpose |
The statement of purpose and disclosure published on its solicitation material, tickets, programs and documents regarding the use of the proceeds shall read: Proceeds are for the benefit of (_________ Shriners) (_________ Shrine Club) activities. Payments are not deductible as charitable |
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Charitable Purpose |
The statement of purpose published on its solicitation material, tickets, programs and documents regarding the use of the proceeds shall read: Proceeds are for the benefit of Shriners Hospitals for Children. |
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Sponsor of the activity:__________________________________________________________
(
Type of activity: _______________________________________________________________
Date(s) of activity:
Where held:___________________________________________________________________
Requested by President or Chairman: _______________________________________________
Mailing address: _______________________________________________________________
Phone: (Business) _________________________ (Home)______________________________
The completion of the above questions follows the Shrine Fund-Raising policy and Procedures as defined in the General Order No 1 under the Fund-Raising Activities section Do not use this form for third party fund-raising events benefiting Shriners Hospitals for Children. A separate letter must be submitted stating the event coordinator’s name, mailing address and phone number
********************Check List For Temple Use Only********************
Request Number___________
Date
Financial results received / /
Request Received / /
Potentate’s Approval / Date File closed / /
For a charitable fund-raiser, assigned Charity Activity Event No. Charitable net proceeds transmitted to Imperial Headquarters: /