Portal Use Form
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Please enable JavaScript in your browser to complete this form.
Name of the Event
*
Enter the name of your Event
Type of Event
*
Event Date / Time
*
Date
Time
Event Location (Venue)
*
Enter the complete name of the venue at which this event is being held
Complete Venue Address
*
Address Line 1
Address Line 2
City
— Select state —
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Event Point of Contact (POC)
*
First
Last
Event POC Phone Number
*
Event POC E-mail
*
Email
Confirm Email
Number of Guests Expected
*
Enter the Maximum amount of guests expected
Price Per Person
*
Total $:
*
Does the event require a security deposit?
*
Yes
No
If the venue does require a security deposit, how will it be/how was it paid?
Cash
Check
Credit Card
Check Made Payable to:
Enter the Name of the Person or Business that the check will be made payable. Reimbursement WILL NOT be made without proof of payment receipt. (Thie may be a credit card statement, cancelled check, or proof of receipt of payment from the venue. DEAF CHECKS ARE ONLY GOOD FOR 30 DAYS FROM THE CHECK DATE. VENDOR MAY BE PAID DIRECT UPON PRESENTATION OF A VALID INVOICE.
Are there multiple pricing options?
*
Yes
No
If Yes, please input all pricing options
Does your price include a gift for an honoree?
*
Yes
No
If Yes, what is the price per person for the gift?
Will you be accepting cash & checks for this event?
*
Yes
No
If yes, I UNDERSTAND AND AGREE THAT ALL PROCEEDS BOTH CASH & CHECK WILL BE DEPOSITED INTO THE DMAVA EMPLOYEE ACTIVITY FUND BANK ACCOUNT. ALL CHECKS MUST BE MADE PAYABLE TO "DMAVA EMPLOYEE ACTIVITY FUND"
Yes – I understand and agree
No
Attach your event flyer
*
Click or drag a file to this area to upload.
SIGNATURE OF EVENT POC – I Agree that by entering my Name below I agree to the terms of this agreement. I understand that there are fees associated with credit card processing which are 4.4% of the total and that there is a one-time fee of $10.00 per event to offset the costs of maintaining the website. It is recommended that the fees you charge take into account these fees as you also have the option to pass them along to your customers.
*
I Agree
VIRTUAL SIGNATURE
*
ENTER YOUR FULL NAME
Website
Submit
