Fundraiser/donation Request Form - Edwards Afb
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3FUNDRAISER/DONATION REQUEST FORM
TO: 412 FSS/CL
FROM: NAME OF PRIMARY POC/PHONE NUMBER
DATE OF REQUEST (2-3 weeks
advance notice)
EDWARDS, CA 93524
NOTICE: I request authorization to hold a fundraising event on EDWARDS AFB, CA. If approved, I further expressly agree to indemnify and
hold the United States of America harmless from and against any and all claims, loss, and liability, however caused, arising out of, or in any
way connected with this event, whether or not caused or contributed to by any negligence or alleged misconduct on the part of any
employee of the United States or member of the United States Armed Forces. I understand should an incident occur the individual members
of the requesting organization, rather than the Air Force, would be liable.
NAME OF PRIVATE ORGANIZATION (PO) OR UNOFFICIAL ACTIVITY
ALTERNATE POC (NAME & PHONE NUMBER)
SIGNATURE
TIME and DATE OF FUNDRAISER
All blocks must be filled out, follow instructions on 2
page
DATE(s) OF LAST FUNDRAISER
nd
Yes No
Check Appropriate Box
DETAILS of EVENT/ACTIVITY: PO or Unofficial Activity needs to plan out the. (Be specific
and if necessary, attach separate page)
1.
Are you a registered PO with
412 FSS/FSR? If no, see #2
Who
2.
If event is sponsored by an
unofficial activity, will you raise
What
more than $1K/per month over
3 months? If so, must consult
Where (exact location of event):
412 FSS/FSR
3.
All participants will be
When
volunteers, not in uniform, & if
event is conducted during duty
Why (How are the funds/donations going to be used?) i.e.,to benefit PO/unofficial
hours will be on leave/pass.
activity, support official AF function, support outside organization. Please be specific:
4.
Does this event involve food?
(Must coord w/Public Health)
5.
Is event location considered
the workplace?
ADVERTISING PROHIBITIONS:
INITIAL ______ ***
The Joint Ethics Regulation prohibits
6.
Does event involve solicitation
(telephones, fax machines, E-mail, the
the use of DoD communication resources
in base housing?
Internet) or any other gov’t resource in any manner that would reflect adversely on
7.
Are you seeking official
the DoD, which specifically includes soliciting and selling (JER sec. 2-301.a. and b
endorsement of this event?
8.
Does event occur during the
***All fundraiser requests during CFC/AFAF have to be approved by 412TW/CC. The
CFC/AFAF drives?
routing process during CFC/AFAF can take up to three weeks. The requests must be
9.
Is NAF or APF equipment being
directed exclusively to the members of the PO. Only registered POs can hold a
used for this event?
fundraiser during CFC/AFAF.
_______________________________
____________
Facility Manager Signature
Date
_______________________________
____________
Public Health Signature
Date
_______________________________
____________
Base Fire Department Signature
Date
DECISION OF APPROVAL AUTHORITY:
APPROVED
DENIED
YOUR REQUEST TO CONDUCT A
FUNDRAISER AT THE TIME AND DATE INDICATED IS:
NAME, GRADE AND DUTY TITLE
SIGNATURE
ALEXANDER A. KOVRAS, NH IV, DAF
Director, 412th Force Support Squadron
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