SafetyFirst Fundraiser Application -- * Development copy *

Please complete our fundraiser promotion application. We do not share, sell or lease your personal information with third parties.
For more information, please see our Privacy Policy.
Required fields are marked with *


Organization Information

*Organization Name:
This will be the login name
*Organization Type:
Example: Church, Elementary School, Charity, etc.
*Street Address:
Street Address 2:
*Zip/Postal Code:
*Phone Number:
*Organization Description:
Example: High School, Church, etc.

Organizer Contact Information

*First Name:
*Last Name:
*Primary Phone Number:
*Primary Email Address:

Promotion Information

*Enter Promotion Start Date: (MMDDYYYY)
Note: Can be changed later. Promotion runs for 2 months.
*Purpose of Promotion:
Example: To purchase new computer equipment for the school library.
*Enter Promotion Code:
Example: Central High School-2011 or CHS2011

I hereby certify that the following is true:

  • I certify that all the information provided in this fundraiser promotion application are true and complete to the best of my knowledge.

  • I am a representative of the aforementioned organization, and the funds generated from the SafetyFirst Fundraiser Program will be used for the reasons stated above, not for personal or corporate profit.

    I so certify and agree.

    All applications are subject to approval.

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