Donation Request Form

**Please note: This is not a contract**

Backroads must receive this completed form at least 60 days prior to the event.

Please return completed form via email to 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 ___________________________________________

Email ___________________________________________

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


Email 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 _____ Multi-Adventure _____ Active Cruises _____ Dolce Tempo

Accommodation (please check) ______ Premiere Hotels ______ Casual Hotels ______ Small Luxury Ships

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


Print name

If you have any questions, please contact Liz Hale by phone at 510-527-1555 ext. 119 or email at