Eureka County Recreation Board Request Form

Required fields are marked with asterisks (*)

Date

Date of Event

Name of Organization

Has the Board donated to you in the past?

Yes

Contact Person(s)

Address

Phone

Donation Request Purpose:

Amount Needed for the Event

Amount Requested for the Event

Describe Who/What will benefit from the donation:

Will the event bring economic stimulus to the community?

Yes

Please describe any other donations already received:

Signature

Clear

Title

Print Name