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Community Day Registration Form
Please Note
Community Days are limited to Monday or Tuesday and there can be only one event per community, per day. A fundraiser is only considered scheduled once you receive confirmation of your date and participating locations. All requests must be submitted at least four weeks prior to the requested fundraising event date (six weeks preferred). You will be contacted within two weeks of receiving your Fundraiser Request Form.
Contact Name
*
Organization Name
*
please no abbreviations or symbols (example Assn., &, @)
Organization Check Is Made Out To:
*
Address check will be mailed to
*
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone (include area code)
*
Alternate Phone (include area code)
Email
*
Community Day Date
*
We need a minimum of 30 days to process your Community Day
MM slash DD slash YYYY
Alternate Community Day Date
*
We need a minimum of 30 days to process your Community Day
MM slash DD slash YYYY
State for Your Community Day
*
Illinois
Indiana
Missouri
Area For Your Community Day
*
Please select
Arcola
Bloomington - Eldorado Ave
Bloomington - Veterans Parkway
Bourbonnais
Canton
Centralia
Champaign - Mattis Ave
Charleston
Clinton
Danville - Vermilion Ave
Decatur - Mt Zion
Decatur - Prospect Dr
Decatur - South Shores Center
El Paso
Fairbury
Gibson City
Gilman
Hoopeston
Kankakee
Mahomet
Manteno
Mattoon
Monticello, IL
Morton
Normal
Olney
Paris
Paxton
Pekin
Peoria - Knoxville Ave
Peoria - Willow Knolls
Princeton
Pontiac
Rantoul
Robinson
Shelbyville
Springfield
St. Joseph
Sullivan
Tilton
Tolono
Urbana
Villa Grove
Washington
Watseka
Area For Your Community Day
*
Please Select
Avon
Fishers
Greencastle
Kentland
Lafayette
Terre Haute
Traders Point
Vincennes
West Lafayette
Area For Your Community Day
*
O'Fallon
Requested Location(s) (Maximum of 2 locations for your event)
*
Bloomington - Eldorado, IL
Bloomington - Veterans Pkwy, IL
Clinton, IL
Normal, IL
Requested Location(s) (Maximum of 2 locations for your event)
*
Champaign - N. Mattis, IL
Mahomet, IL
Rantoul, IL
St. Joseph, IL
Urbana, IL
Requested Location(s) (Maximum of 2 locations for your event)
*
Charleston, IL
Mattoon, IL
Sullivan, IL
Requested Location(s) (Maximum of 2 locations for your event)
*
Danville - N. Vermilion, IL
Hoopeston, IL
Tilton, IL
Requested Location(s) (Maximum of 2 locations for your event)
*
Decatur - Mt. Zion, IL
Decatur - Prospect Dr., IL
Decatur - South Shores Ctr, IL
Monticello, IL
Springfield, IL
Requested Location(s) (Maximum of 2 locations for your event)
*
Bourbonnais, IL
Kankakee, IL
Manteno, IL
Requested Location(s) (Maximum of 2 locations for your event)
*
Canton, IL
Morton, IL
Pekin, IL
Peoria - N.Knoxville, IL
Peoria - Willow Knolls, IL
Washington, IL
Requested Location (Please Select)
*
Arcola, IL
Requested Location (Please Select)
*
Centralia, IL
Requested Location (Please Select)
*
Chillicothe, IL
Requested Location (Please Select)
*
El Paso, IL
Requested Location (Please Select)
*
Fairbury, IL
Requested Location (Please Select)
*
Gibson City, IL
Requested Location(s) (Maximum of 2 locations for your event)
*
Gilman, IL
Watseka, IL
Requested Location (Please Select)
*
Olney, IL
Requested Location (Please Select)
*
Paris, IL
Requested Location (Please Select)
*
Paxton, IL
Requested Location (Please Select)
*
Pontiac, IL
Requested Location (Please Select)
*
Princeton, IL
Requested Location (Please Select)
*
Robinson, IL
Requested Location (Please Select)
*
Shelbyville, IL
Requested Location (please Select)
*
Tolono
Requested Location (Please Select)
*
Tuscola, IL
Requested Location (Please Select)
*
Villa Grove, IL
Requested Location (Please Select)
*
Lafayette, IN
Requested Location(s) (Maximum of 2 locations for your event)
*
Kentland, IN
Watseka, IL
Requested Location (Please Select)
*
Delphi, IN
Requested Location (Please Select)
*
West Lafayette, IN
Requested Location (Please Select)
*
Monticello, IN
Requested Location (Please Select)
*
Avon, IN
Requested Location (Please Select)
*
Fishers, IN
Requested Location (Please Select)
*
Traders Point Mall in Indianapolis, IN
Requested Location (Please Select)
*
Greencastle, IN
Hidden
Requested Location (Please Select)
*
Greenwood, IN
Requested Location (Please Select)
*
Terre Haute, IN
Requested Location (Please Select)
*
Vincennes, IN
Requested Location (Please Select)
*
Vincennes, IN
Requested Location (Please Select)
*
Glendale Mall in Indianapolis, IN
Hidden
Flier Color
*
Please Select
Light Blue
Canary Yellow
Green
Salmon
Sun Yellow
Ultra Fuscia
Ultra Orange
Lime Green
Orchid
Red
Lemon
Additional Comments
Community Day Agreement
*
I understand that I may be requested to provide proof that we are a non-profit organization with a 501(c)(3) classification and that I have read and agree to the program guidelines.
75132
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