Independent Fundraiser Contact Form

Name*
First Last
Email*
Address*
Street 1 Street 2 City State ZIP
Phone Number*
- Yes, I would like to receive communications from Canine Companions®.
I have read and agree to follow the fundraising guidelines*
Click here for guidelines
- Yes
- No
Group or business name
Event name*
Event date*
Month
Day
Year
Is this a virtual event?*
- Yes
- No
Event location*
Street 1 Street 2 City State Zip
Please provide a brief description of the event and how it will raise funds and awareness for Canine Companions*
Will any other organizations also benefit from this event/fundraiser?*
- Yes
- No
If yes, please list them.*
Will the event be open to the public?*
- Yes
- No
Estimated funds to be donated to Canine Companions
Please provide me with Canine Companions brochures to hand out to attendees / potential donors*
- Yes
- No
Type of brochure
- General information brochure
- Veteran's brochure
- Puppy raising brochure
- Other
If other, please specify
How many?

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