Awareness Event Request

After submitting this form, you will be redirected to the NCKDSS Home page. This form will be sent to the NCKDSS Board of Directors.

If you have any questions, please contact Shella Thoman at nckdssbuddywalk@yahoo.com or call 785-275-1777.

Name of Requestor

Street Address

City, State, Zip Code

Phone Number

Additional Hosts and/or Volunteers:

Event Name:

Event Date:

Event Location:

Description of Event

Who will participate?

How many participants do you estimate?

Is there a charge to participate?

Yes
No

If yes, what is the charge?

Do you anticipate raising money?

Yes
No

If yes, what do you anticipate to net?

Under $100
$100 - $500
More than $500

What assistance are you requesting from the NCKDSS? Check all that apply.

Direct Payment for:

Location
T-shirts
Food Items
Other (Indicate in comments)

Reimbursement for items purchased by host(s)

Location
T-shirts
Food Items
Other (Indicate in comments)

Items requested to be provided by NCKDSS

Flyers for Event
Prize Items (NCKDSS Merchandise)
Operating Cash Event Day
NCKDSS Merchandise to sell (Indicate in comments)
Other (Indicate in comments)

Attach Picture, Flyer, etc.

Please enter any additional comments or notes. Thank you.