REQUEST FOR DONATION FORM
**THIS IS NOT A CONTRACT**
BACKROADS MUST RECEIVE THIS COMPLETED FORM AT LEAST 60 DAYS PRIOR TO THE EVENT
Please print and return to Liz Hale via fax at 415-464-9511. Once your application is received, you will be contacted by Backroads regarding the status of your request.
Name of organization ________________________________________________
Name of event ________________________________________________
Type of event (please check one)
______ Live ______ Silent ______ Online
Date of event _________________________
Projected attendance ___________________
Fund-raising goal $_____________________
Location of event (please include city and state) ____________________
Name of primary contact ________________________________________________
Primary contact mailing address ____________________________________
Phone ___________________________________________
E-mail ___________________________________________
Fax ________________________________________________
How will Backroads be promoted before and during your event?
________________________________________________
________________________________________________
Deadline to include logo in event invitation
________________________________________________
Deadline for promotional trip copy and images
_______________________________________________
E-mail address and contact information of printer/designer
________________________________________________
Format for logo (please check) ______ JPEG ______ EPS ______ PDF
Please specify one trip requested for donation
________________________________________________
Trip name as it appears in catalog or on the Web
________________________________________________
Catalog Name _____________________________________
Catalog Page # _______
Activity (please check) ______ Biking ______ Walking/Hiking _____ Multisport
Accommodation (please check) ______ Premiere Inns ______ Casual Inns ______ Camping
Total retail trip cost of one (must include internal airfare, if applicable), as it appears in catalog/Web $_______________________________________________
Retail value for trip for two (previous answer x 2) $__________________
Minimum bid required (previous answer x 75%) $________________________
Other auction items at your event
________________________________________________
I understand that Backroads will donate one trip and the organization will purchase one trip ______ Yes ______ No
I understand that the minimum bid requirement is no less than 75% of the total retail cost of the trip for two ______ Yes ______ No
I understand that auction committee members and those associated with the organization are not eligible to win the Backroads trip __ Yes __ No
I have read and understand the program policies ______ Yes ______ No
Signature
________________________________________________
Print name
________________________________________________
If you have any questions, please contact Liz Hale by phone at 510-527-1555 ext. 119 or e-mail at lizh@backroads.com.
