Portion of Proceeds Application Question Title * 1. Please fill out the information below: Name: * Company: Address: * Address 2: City/Town: * State: * -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: * Country: Email Address: * Phone Number: * Question Title * 2. Please describe in detail how you will be raising funds that will be donated to Celiac Disease Foundation. Question Title * 3. Please state the exact amount that will be donated to the Celiac Disease Foundation. For example, "One dollar of each product/service" or "25% of monthly sales" or "100% of event proceeds." Question Title * 4. Do you agree not to market or sell any product or service that bears the Celiac Disease Foundation's Team Gluten-Free® or Celiac Disease Foundation logos and/or names? Yes No Question Title * 5. Do you agree to receive approval from Celiac Disease Foundation PRIOR to publishing your promotional materials, including website and social media promotion? Yes No Question Title * 6. Do you agree to include a disclaimer on all promotion material that reads as follows: "The Team Gluten-Free® name and logo and Celiac Disease Foundation name are used with its permission, which in no way constitutes an endorsement, express or implied, of this product/service/event."? Yes No Question Title * 7. Do you agree that all your promotion materials will state the exact amount that will be contributed to Celiac Disease Foundation? (As described in question 3) Yes No Question Title * 8. Do you agree that, within four weeks after the end date of your fundraising event, you will provide an accounting of your sales along with your contribution to Celiac Disease Foundation? Yes No Done
