Please fill out the application below if you are interested in hosting a Steps for a Cure Event

Please fill out this form and return it to DSF to obtain approval for your DSF Steps Toward a Cure
event. Promotion and solicitation for your event is prohibited until approval of event has been given. Questions? Email misty@dravetfoundation.org

Name(Required)







Address













Have you been convicted of a felony or misdemeanor?





Is this your first time coordinating a fundraising event?





Is this your first time coordinating a fundraising event for DSF?





Site/Venue Information

Address















MM slash DD slash YYYY

Registration Start Time



:




Event Start Time



:




Does the venue require a Certificate of Insurance?





Are restrooms available onsite?





Is there a shelter in case of inclement weather?





Is there ample free parking?





Is the walk area paved/smooth for wheelchairs and strollers?





Are dogs on a leash permitted?





Are you responsible for trash removal?





Raffle/Silent Auction Information:

Will your event have a silent auction?





Will your event have a raffle?





Does your city/state require a permit for the silent auction or raffle?





Have you confirmed the venue permits a silent auction or raffle?





Event Details

What time does your event start?



:




What time will your event end?



:




Expenses(Required)

DSF Steps Toward a Cure events are designed to incur very little overhead costs to assure that the maximum amount of money raised is going directly to our programs and services. Coordinators are not expected to take responsibility for any of the expenses associated with the event. DSF will pay for site site fees of up to $400 and raffle permit fees of up to $100. If fees for either are more than the stated amount, you must contact DSF for approval prior to signing any paperwork. It is important to remember that DSF will not pay for, nor reimburse any costs that were not previously approved. Approved costs can only be refunded upon receipt of a completed expense reimbursement form and necessary documentation (receipts, contracts, etc.) By checking here, you indicate that you have read and understand the Expenses section and agree to follow the outlined procedures.

Funds Raised(Required)

I understand that all funds raised in conjunction with a Steps Toward a Cure event is strictly for the benefit of the Dravet Syndrome Foundation. I also understand that no funds may be allocated for a specific child or family and may not be taken for personal use.


BY SIGNING AND SUBMITTING THIS FORM YOU ARE ACKNOWLEDGING THAT ALL OF THE
INFORMATION PRESENTED IS ACCURATE AND NOT FRAUDULENTLY REPORTED.








The information collected by Dravet Syndrome The information collected by Dravet Syndrome Foundation will not be sold or distributed outside of DSF and is used solely to verify identity and assist with communication. Questions or concerns can be directed to our team

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