100 Club of Arizona Event Proposal

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* 1. Initial Contact Date

Date / Time

Date

Time

AM/PM

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* 2. Name

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* 3. Name of Company (If Applicable)

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* 4. Title

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* 5. Mailing Address

Name

Address

City, State

Zip Code

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* 6. Cell Phone

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* 7. Business Phone

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* 8. Email Address

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* 9. Type / Name of Event

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* 10. Purpose(s) of Event

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* 11. Location/Venue

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* 12. Proposed date/time of event

Please enter proposed date and time.

Date

Time

AM/PM

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* 13. Proposed number of Attendees

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* 14. Estimated Cost for Attendees (if applicable)

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* 15. Information and Description of Event

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* 16. Estimated cost to the 100 Club

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* 17. Reasons for cost

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* 18. 100 Club Responsibilities - Volunteers needed? How many?

Yes

If you answered YES - How many volunteers?

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* 19. 100 Club Information Table requested?

Yes

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* 20. 100 Club of Arizona Speaker requested? (If available)

Yes

If you chose YES, How long will the speaker be needed?

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* 21. Percentage of proceeds to be donated to the 100 Club

100

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 22. How will the money be donated to the 100 Club (e.g. cash at event, check hand delivered after, check mailed after)

If you have any questions or concerns, please email events@100club.org. Please call our office at (602) 485-0100 if you do not receive a response within 24-48 business hours. Thank you for your submission.