Ipic Donation Request Form
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1C
D
R
F
HARITABLE
ONATION
EQUEST
ORM
The iPic Gold Class Entertainment Donation Program is intended to assist the not-for-profit sector. The program’s main goal is to
acknowledge not-for-profit volunteers and encourage donations to 501(c)(3) charitable organizations dedicated to the benefit and
advancement of the human or animal condition, which benefit the community at large.
The program is not intended for the for-profit sector including organizational meetings, holiday parties, employee incentives,
customer rewards or third-party donations (wherein the donation is being passed along through a for-profit company to a charity.)
No monetary donations are given; our donation is for two Premium Plus tickets – valid Monday through Thursday, except holidays
and holiday eves.
If your donation is approved, you will receive notice from IGCE approximately 5-6 weeks after your request was received.
Donations are not guaranteed and due to the high volume of requests, not all are approved.
A
I
PPLICANT
NFORMATION
□
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Organization:_________________________________________________________________ 501(c)(3) No
Contact:_______________________________________Title:________________________________________
Address:___________________________________________________________________________________
City/State/Zip:______________________________________________________________________________
Phone:____________________________________________________________________________________
E-mail Address:_____________________________________________________________________________
IMPORTANT
1. C
. D
.
OMPLETE APPLICATION
O NOT LEAVE ANY QUESTIONS UNANSWERED
2. M
501(
)(3)
AIL YOUR APPLICATION ALONG WITH YOUR
C
ELIGIBILITY WAIVER AND A
-
,
.
SELF
ADDRESSED
STAMPED ENVELOPE
3. A
LLOW A MINIMUM OF FIVE WEEKS TO RECEIVE A RESPONSE
I
,
.
F ANY INFORMATION IS OMITTED
YOUR APPLICATION CANNOT BE PROCESSED
ONE DONATION PER CALANDER YEAR PER ORGANIZATION
1. When does your event take place? _______________________________________________________
2. Please describe how the donation will be used:______________________________________________
____________________________________________________________________________________
3. Please describe who or what will benefit from our donation:
____________________________________________________________________________________
____________________________________________________________________________________
Is your event, effort or purpose affiliated with any political, religious, family-planning, pro-tobacco-
4.
□
□
related or pro-alcohol-related cause or organization?
Yes
No
If yes, please explain: __________________________________________________________________
____________________________________________________________________________________
To submit: Mail Complete Application and 501(c)(3) form
iPic Entertainment / Donation Request ● 433 Plaza Real Boulevard, Suite 335, Boca Raton, FL 33432
or scan the completed form, attach the 501(c)(3) form, and email to:
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