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Release of Liability and Waiver

Sign the Waiver

Donation Request Form

Fill Out the Form

Thank you for your interest in partnering with Synergy Float Center. To be sure we act in the best interest of both your organization and ours, we ask that you please complete this application form. This ensures the potential partnership is a good fit for both of us and simplifies the planning process should we choose to proceed. We value the organizations that keep our community strong and we are delighted to review your request. Please submit your request at least 30 days prior to the date of your event.

Full Name of Your Company/Organization*
Address of Your Company/Organization*
Street Address Address Line 2 City State ZIP Code
Company/Organization Website*
Brief Description About Your Company/Organization*
Primary Person Contact Name*
First Last
Primary Contact Person Phone*
Primary Contact Person Email*
Who is the beneficiary of the funds raised?*
Please describe the nature of your event.*
Event Location
Street Address Address Line 2 City State ZIP Code
What date does your event start?
MM slash DD slash YYYY
What date does your event end?
MM slash DD slash YYYY
What time does your event start?

: Hours

Minutes

AM/PM
What time does your event end?

: Hours

Minutes

AM/PM
What is the deadline for donation submission?
Leave blank if there is no deadline.
MM slash DD slash YYYY
What time is the deadline for donation submission?
Leave blank if there is no deadline.

: Hours

Minutes

AM/PM
What type of contribution are you seeking?*
Why are you choosing Synergy Float Center as a partner for your event?*
What are the marketing opportunities for Synergy Float Center?*
Do you have any additional information about your event or organization you would like us to consider when reviewing your request?
While we are very appreciative of your interest, please note that submitting this application for consideration by Synergy Float Center does not guarantee a donation. We will thoughtfully review your request and notify you if we are able to contribute to your organization’s event. Thank you!
Signature*
Name
If different than the contact person noted above.
First Last
Comments
This field is for validation purposes and should be left unchanged.

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Release of Liability and Waiver

Donation Request Form

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