Name

First Last

DATE INFORMATION

Rationale for event:(Required)

Community Outreach (Pancake Breakfast, Santa Parade, etc.)

Company Event (Banquet, Holiday Dinner, etc.)

Fundraiser (5K, Christmas Tree Sales, Chilly Days, etc.)

Public Education (Open House, etc.)

Other - Please specify below.

Please enter "Other" type of event from above:

Name of the Event:(Required)

Proposed Date:(Required)

Alternative Date:

Rational for Date:(Required)

Are their any conflicts regarding date? If so, please explain below:(Required)

Location of Event:(Required)

Have you confirmed location is available and no conflicts exist?(Required)

Yes

Is Coordination with Career Captain Required?(Required)

Yes

If coordination is required with Career Captain, what type of coordination is needed and have you contacted them?

PROPOSED BUDGET INFORMATION

Please identify all expected expenses (ie. t-shirts, raffles, give aways, food expenses; rental expenses; equipment procurements; team meals, etc.), below and include the budget code for each entry. If a particular expense exceeds $500, provide as much detail as possible to help the Board understand the expected items being purchased (e.g., we expect to issue gift cards to recognize members at a picnic that will cost up to $750, with no one card greater than $25). File with expenses can be attached below.

File

Max. file size: 200 MB.

Contingency - Describe how much and rationale for amount (if estimates are based on firm quotes, contingency should be less than 10% of overall costs; if estimates are not based on firm quotes, additional contingency should be added):(Required)

ESTIMATED INCOME SECTION FOR FUNDRAISING EVENT

Define expected income for event:

Describe in detail basis for estimate (e.g. raffle sales, AVFRD swag sales, admission charge, donations, etc.):

OUTREACH SECTION

What outreach will be required to promote the event:(Required)

Outreach to County Officials

Outreach to LCFR leadership

Outreach to other Loudoun County Volunteers

Outreach to AVFRD Members

Outreach to Public

Other Outreach

Proposed Team Lead(s):(Required)

Team Members:(Required)

Expected Results (e.g. 200 AVFRD members will attend celebration for their service, etc.):(Required)

Upload any supporting documentation for the event.

Drop files here or

Max. file size: 200 MB, Max. files: 5.

Event Request Form

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Event Request Form

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