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FUNDRAISING ACTIVITY REQUEST

ANSAR SHRINE

Club/Unit:

Submitted By: Phone Number:
Sponsored by:
Location of activity:
Type of activity:
Date of activity: Time:
Planned distribution of proceeds: Fraternal Charitable

Potentate Approval:_____________________________________ Date: ___________________

Financial Report (Complete only after event)

1) Prior years reserve (if any) $_________
Receipts:

2) Cash collected $________
Donations $________
Interest $________
Other $________
Total gross receipts $__________

Expense

3) Direct fundraising expenditures $________
Performers $________
Venue Rental $________
Food and beverage $________
Other $________
Subtotal $_________

Indirect fundraising expenditures
Advertising $________
Sales promotion $________
Supplies $________
Postage $________
Equipment rentals $________
Charity gifts $________
Center administrative costs $________
Total expenses $_________

4) Net profit of loss (#1 plus #2 minus #3) $_________

Distribution (club, unit or hospital) _______________________

Financial report submitted by_____________________________ Phone _________________

No Shriner, club, unit or organization of Nobles should engage in any fundraising activity, whether it be for charitable or fraternal purpose without first obtaining written consent of the Potentate. Please submit this form before the event, with rough drafts of the published articles, graphic designs and disclaimer statements complying with Imperial Council rules and regulations. Approval will be returned as soon as possible.

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Timestamp

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August 15, 2025 1:19 pm CDT

FUNDRAISING ACTIVITY REQUEST Uploaded by Tony Moore - ansaroffice@ansarshrine.com IP 140.141.212.112