Group organizer name *

First Name

Last Name

Organization address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Organization phone number *

(###)

###

####

Organizer's direct phone # *

(###)

###

####

What date would you like to hold your fundraiser? *

MM

DD

YYYY

By checking the box below and typing my name below, I understand that I am electronically signing this agreement and certify that I have read and understand the Malek's Pizza Palace Fundraiser guidelines and FAQ's and agree to uphold my responsibilities as a group representative. I understand that Malek's Pizza Palace reserves the right to approve or disapprove the fundraiser and may cancel with no penalty in rare occasion or an emergency. *

*

First Name

Last Name

What is the mailing address for us to send you the fundraising check? *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country