STERLING HEIGHTS FUNDRAISING & EVENTS

SHELBY TOWNSHIP FUNDRAISING & EVENTS

Application for Art & Jakes Kickback Program
Name of organization*
Check made payable to:*
Address*
Street Address City State ZIP Code
Mailing Address for Check if different from above
Street Address City State ZIP Code
Tax ID or Charitable Tax Exempt Number*
Contact Name*
First Last
Email*
Phone*
Date I would like to hold my Art & Jakes event (Monday –Thursday Only)*
Disclaimer
I understand that by returning this form to Art & Jakes Sterling Heights location, I am requesting that someone contact me to discuss the event. I further understand that by returning this form, Art & Jakes is under no obligation to host the event. If we agree to schedule the event, the organization that I represent will not hand out flyers within the perimeters of the restaurant or parking area on the day of the event. Doing so may result in immediate cancellation of the event. I grant permission to Art & Jakes to use my organization’s name and donation amount from the above event in response to media inquiries*
- I agree with the information above

Raychel Flanigan
raychelflanigan@gmail.com