All fields required!

Name of Organization:

Organization Address:

Organization City AND State:

Organization Zip Code:

Your Full Name:

Phone Number:

Email Address:

All fields required!

Ever held a fundraiser with us?: please make a selection no yes

Would you like to be contacted for more info on a Super Star Event?: please make a selection no yes

All fields required!

Name of the Event:
Name of event for which you are requesting a donation of free passes.

Location of Event (city):

Date of Event:

Expected Attendance:

Event Description:
Briefly describe the event you have planned and how the free passes will be used.

Date Donation Required:

Pick up location: please make a selection Ann Arbor Canton Farmington Lansing Taylor Utica Waterford
Please select a store at which you will pick up your donations, as we we do not mail them.

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