This form may be submitted on-line, or printed out and mailed to: GWGVFD, 801 Russell Av., Gaithersburg, MD 20879.

Indicates Required Field

Name of Event:
Name of Location:
Address 1:
Address 2:
City:
State:
Sponsoring Group:
Point of Contact (POC):
POC email:
POC Phone Number(s) - atleast one phone number is required
Work Phone:
Home Phone:
Cell Phone:
Event Date:
Time (Start to Finish) (CANNOT EXCEED 4 hours on site):
Expected number of children ages 4-12:
Special needs children:		Yes No
If yes, please comment:
Donations are very much appreciated. As a guideline, average donations by corporations is $250, and by schools $100. However, any donation amount is greatly appreciated. Please make checks out to the GWGVFD Fireman's Fund.