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 LizH@backroads.com. 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
Signature
________________________________________________
Print name
________________________________________________
If you have any questions, please contact Liz Hale by phone at 510-527-1555 ext. 119 or email at lizh@backroads.com.