Portion of Proceeds Application Form

Business/Sponsor Organization Name

Primary Contact First Name:

Primary Contact Last Name:

Title:

Business Address:

City

State

ZIP code

Phone

Website(s)

Social Media Sites (Instagram, Facebook, Twitter, etc.)

Describe your Portion of Proceeds campaign and how you intend to raise money:

Provide the timeframe of your PoP campaign (Start date and End date):

How do you plan to publicize your PoP campaign? Please explain outreach materials (e.g. web page(s); advertisement(s), etc.:

Will this be a flat contribution, or percentage of proceeds? Please detail amounts or percentages.

Will the Foundation be the sole beneficiary? If splitting proceeds with another entity, what are the amounts designated for each beneficiary?

What is the contribution you hope to raise for the Foundation?

Have you ever sponsored a PoP campaign for the Foundation before? If yes, please provide the campaign name and year(s) hosted.

What is your primary connection to Parkinson’s disease?

Any other information to share about your Portion of Proceeds fundraiser?

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