Donation Requests | Rosie's Gaming Emporium

This request form has two sections:

Section 1 provides us the basic information about your organization and your mission, as well as information on how Rosie’s team members can recognize their partnership in your event or program. Section 2 provides details on what type of contribution you are seeking.

Section 1: Organization Information

Organization Name*

Contact Person Name*

First Last

Contact Person Title*

Phone*

Email*

Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Under what IRS section do you qualify as a non-profit? (e.g. 501(c)(3))*

Section 2: Contribution Details

Tell us about your area of need.

Does this event or program support any other community organizations? If yes, please specify*

At the requested level, how would Rosie’s receive recognition?*

(Check all that apply)

Select Media For Logo Placement:

Radio
TV
Web
Print

Naming Rights (Indicate What Would be Named)

(Please Specify)*

Event or Project Name:*

Event Date(s) or Timeline:*

How many years has the event/project taken place?*

What is the scope of event/project and who does it benefit?*

What is the primary purpose for this event?*

(Please Specify)*

We need:*

Volunteers
Food & Beverage
Event Planning Assistance
Food and Drink Advice
A Place for the Event
Cash Donation
Co-sponsorship

Number of Volunteers Needed:*

Food & Beverage for how many people?*

What kind of food & drink?*

Cash Donation Requested*

Co-sponsorship Donation Requested*

Please tell us how we can help with your event, organization or both?

Which Rosie’s is closest to you?*

Required Attachments*

Please attach the following required documentation to fully evaluate your request:
IRS Form W-9
IRS 501(c)(3) Letter of Determination

Drop files here or

Other Attachments

Please attach the organization's mission statement, a list of sponsorship levels, if applicable, and any additional explanations to questions on this application if necessary. Complete a separate form for each request.

Completed form should be submitted on or before the dates below:
Events within these months:
October, November, December due by 5PM on August 15
January, February, March due by 5PM on November 15
April, May, June due by 5PM on February 15
July, August, September due by 5PM on May 15

Terms & Conditions*

Review the terms and conditions associated with receipt of the requested donation by clicking HERE.

I have read and agree to the Terms and Conditions.

Signature and Title of Requesting Organization Representative:*

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Rosie’s Gives Back Donation Requests

Section 1: Organization Information

Section 2: Contribution Details