Fundraiser Request Form
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1
2FUNDRAISER REQUEST FORM
TO:
FROM: NAME OF RESPONSIBLE INDIVIDUAL/PHONE NUMBER
DATE OF REQUEST:
88 FSS
WPAFB OH 45433
NOTICE: I request authorization to hold a fundraising event on WPAFB OH. If approved, I further expressly agree to indemnify and hold the United States of
America harmless from and against any and all claims, loss, and liability, however caused, arising out of, or in any way connected with this event, whether or not
caused or contributed to by any negligence or alleged misconduct on the part of any employee of the United States or member of the United States Armed
Forces. I understand should an incident occur, the individual members of the requesting organization, rather than the Air Force, would be liable.
ORGANIZATION REPRESENTED (Name and Address)
TIME(s) and DATE(s) OF THIS FUNDRAISER
SIGNATURE
DATE(s) OF LAST FUNDRAISER
To Complete Form Please Read Instructions on Reverse
NO. OF EXPECTED PARTICIPANTS
ADULTS
CHILDREN UNDER 12
-Please Print-
Yes No
Check Yes or No
DETAILS of your event e.g.: WHO: ABW Top Three Association WHAT: wishes to hold a
cookie sale, WHERE: in the lobby of the Wing HQ building 10, WHY: funds to be used to
1.
The requesting organization is
offset cost of a unit party. (Be complete and if necessary, attach more information on
primarily made up of AF/DoD
a separate page.)
members.
2.
All participants will be volunteers,
Who:
not in uniform, and, if the fundraiser
is conducted during duty hours, will
be on leave or special pass.
3.
This event will not involve food
preparation. (If so, see reverse)
What:
4.
The location of this event is not
considered the workplace.
5.
This event will not involve solicitation
in base housing.
Where:
6.
Official endorsement of this event is
not desired.
7.
If event is sponsored by an
unofficial activity, its assets were
below $1000 average for the last 3-
Why:
month period.
8.
This event will not occur during the
CFC or AFA drives.
Advertising: The Joint Ethics Regulation prohibits the use of DoD communication
9.
This is either the first or second
resources (telephones, fax machines, E-mail, the Internet) or any other Government
fundraiser event in this calendar
quarter.
resource in any manner that would reflect adversely on the DoD, which specifically
includes soliciting and selling (JER sec. 2-301.a. and b).
COORDINATION (see reverse)
A:
B:
C:
D:
E:
F:
G:
OFFICE
Initials/ Date
ABW/JA RECOMMENDATION:
Approval
Denial
Signature:
Review Date:
Qualifies as: _____A local INTERNAL program AWAY FROM the workplace
_____A local INTERNAL program AT the workplace
(AFI 36-3101, Table 1, Rule 4)
(AFI 36-3101, Table 1, Rule 3)
_____OTHER ( __________________________________________________ )
Remarks:
DECISION OF APPROVAL AUTHORITY:
YOUR REQUEST TO CONDUCT A FUNDRAISER AT THE TIMES AND DATES INDICATED IS:
APPROVED
DENIED
REMARKS/LIMITATIONS
NAME, GRADE, AND DUTY TITLE
SIGNATURE
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