TO: Potentate, Ansar Shriners, located in Springfield, IL
RE: Temple Approval to Conduct a Shrine Fraternal Fundraiser
We respectively request permission to hold the following Fraternal fundraising activity for the benefit of:
We understand that the statement of purpose and the disclosure published on any solicitation materials, tickets, programs, and documents, including all electronically transmitted material, regarding the use of proceeds shall read:
Proceeds are for the benefit of:
Payments are not deductible as charitable contributions.
CHECK ONE
Sponsor of the activity:
Type of activity:
Date(s) of activity:
To be held:
Requested by: Title:
Mailing Address:
Phone: Cell
Home
Email
TEMPLE OR REVIEWING ATTORNEY:
I, ______________________________________________, attorney for Ansar Shriners having received and reviewed the written description, contracts, applications or registrations, along with the applicable sections of the General Orders as noted above, am of the opinion that the laws of _________________________________________, where the activity is to be held, support the Potentate’s approval of the requested fundraising activity and have provided the temple Potentate a written opinion to that effect.
Signed: ____________________________________________________, Temple/Reviewing Attorney
Potentate’s Approval: _________________________________________, Date: _______________________
The completion of the above follows the Temple Governance section, along with the Shrine Fundraising policy and procedures of the current General Order No. 1, under the Fundraising Activities section.
Do not use this form for fundraising events benefitting Shriners Hospitals for Children.
Received by Shriners International Headquarters: _____________________ Date: _________________
