Childhood Stroke Awareness Event Information Form

We are very appreciative of  your efforts to increase pediatric stroke awareness and to raise funds to support CHASA programs.  By hosting an event, you become a part of our critical effort in helping to raise awareness and support for our little stroke and hemiplegic cerebral palsy survivors.  We are happy to provide guidance to help you organize an independent fundraiser or event to benefit CHASA. You can help us learn more about your event by filling out this Event Information Form.


Name



Address


City

     
State/Province               Zip Code


Home  Phone

Work   Phone

Cell Phone


E-Mail

 

Tell us a little about the event or gathering that you plan to host -   name of event, type of event, date, location, anticipated number of participants (we realize you may be in the beginning stages of planning, so just include the details that you have at this time)

 

Are you planning an "Event" or a "gathering of friends".  Your fundraiser is an "Event" if you can answer yes to any of the following questions:

1. Are you going to be advertising the event? Yes  No

2. Is the event going to be open to the public or will you be asking the public for donations? Yes  No

3. Are there going to be people attending that you don't know? Yes  No

4. Does it involve any high risk activity like sports, or activities requiring a license like gambling or raffles?
Yes  No

5. Will you be asking local businesses to donate merchandise? Yes  No

6. Are you expecting to be reimbursed for any expenses? Yes  No

If you didn't answer yes to any of the above questions, then you are going to have a small fundraiser involving your friends and family and we don't consider this an "Event", so you don't need to answer the next two questions.

 

Please provide us with names of others who will help you host and organize this event.

 

What motivated you to host this event?

Additional questions or comments

We're excited to learn more about your plans.  A volunteer from CHASA will contact you to let you know that we have received your event information form and to share information that can help you produce a memorable and successful event.

Please check your spam and junk mail box in case your spam filter accidently places our reply message there.

Thank you for helping spread the word that Kids Have Strokes, Too!  Together, we can make a difference.

 ~ CHASA Board Members Nancy, Julie, Jana, Jackie, and Joni