Ronald Mcdonald House Charities of Madison, Inc

Ronald McDonald House Charities of Central Indiana (RMHCCIN) 435 Limestone Street | Indianapolis, IN 46202 | PH: 317-269-2247

RMHCCINThird Party Event Fundraising Application

Sponsoring Organization:

Organization / Contact Person
Address (Contact Person) / Apt or Suite
City / State / ZIP Code / Email
Home Phone Number / Work Phone Number / Fax Number (to fax approved form to)
Organization’s Purpose / Size of Membership(if applicable)

Special Event Information:

Description of Event
What percent of the net proceeds (no less than 50%) will be donated to RMHCCIN?
______%
Location(s) of Event / Date(s) of Event
Anticipated Income from Event
Gross: $______Net: $______Anticipated Date of Distribution to RMHCCIN ______
Name and Address of Insurance Carrier (Attach copies of certificates)
Are Permits Required? _____ If Yes, Please Describe and Attach Copies of Permits.

Other Information:

How will the event be promoted?
Will this event involve the serving or association of alcoholic beverages?
 Yes No
Will the Ronald McDonald House Charities of Central Indiana logo
be used inconjunction with other logos, trademarks, etc.? Yes No
Allproofs with RMHCCIN logo must be approved by RMHCCIN.
Has this group ever sponsored an event for Ronald McDonald House Charities of Central Indiana?
 Yes No

Terms

Sponsoring Group’s Third Party Event Agreement

We will conduct a Third Party Event for the benefit of Ronald McDonald House Charities of Central Indiana (RMHCCIN)in accordance with the provisions of this proposal and letter.
We will maintain the insurance coverage evidenced by the Certificate of Insurance accompanying this proposal throughout the pendency of the event.
Our conduct of the event will conform to applicable laws, rules, regulations and ordinances.
We will not use any trade or service mark or related copyright or McDonald’s Corporation (“McDonald’s”), except as authorized by McDonald’s.
All material using the Ronald McDonald House Charities of Central Indiana name or logo will be submitted by sponsoring group to the Ronald McDonald House Charities of Central Indianafor approval prior to the publication or use of such material. Please allow 15 working days, from date of application, for approval from RMHCCIN staff.
Sponsor will indemnify and hold McDonald’s, its subsidiaries, affiliates, and franchisees, Ronald McDonald House Charities of Central Indiana and their respective trustees, directors, officers, employees, volunteers, and agents harmless from and against any and all claims, liabilities, judgments, penalties, settlements, losses, damages, and expenses, including court costs and reasonable attorney’s fees, incurred or suffered by these parties in connection with or as a result of the event.
Sponsor Signature: ______Title: ______Date: ______

Ronald McDonald House Charities of Central Indiana Consent

In consideration of your sponsorship of a Third Party fundraising event for the benefit of Ronald McDonald House Charities of Central Indiana, as more fully described in this proposal, Ronald McDonald House Charities of Central Indianahereby approves or disapproves (circle one) to your sponsorship of the event upon the terms and subject to the conditions set forth herein.
RMHCCIN Staff Signature / Title / Date
RMHCCINCEO Signature / Title / Date
Please complete and return this application to Ronald McDonald House Charities of Central Indiana.
No fundraising activity will be approved without receipt of a completed form.
Please allow RMHCCIN staff 15 working days to review/approve this application.
Send to:
Ronald McDonald House Charities of Central Indiana
Attn: Savannah Ball

435 Limestone Street

Indianapolis, IN 46202-2819

Phone: (317) 267-0605 Ext. 209  Fax: (317) 267-0610

Thank you for supporting Ronald McDonald HouseCharities of Central Indiana.

OCT 2011