The following information must be completed in order to process and schedule your fundraiser. Once your request is submitted you will receive a confirmation e-mail with additional details.

Fields marked with * are required.
FUNDRAISER INFORMATION
* Today's Date:
* Benefiting What Group or Team?:   (Example: South Lake High School PTA)
* Approximate Number of Members in Your Organization:
* Isaac's Location for Fundraiser:	-- Choose Location -- Centerville Downtown Lancaster Ephrata Exton Granite Run Greenfield Harrisburg/Linglestown Rd. Harrisburg/Paxton St. (Near Bass Pro) Hershey Lemoyne/West Shore Plaza Lititz Mechanicsburg/Rossmoyne Bus. Ctr. Mechanicsburg/Silver Spring Commons Reading Strasburg Thornbury East York (near Galleria Mall) South York (In South York Plaza) West York Hanover Not Applicable
* Date for your Fundraiser:    Fundraisers must be set at least 21 days in    advance, Sunday-Thursday, 5pm-9pm.    Click Here to see available dates on our    Fundraising Calendar.	1st Choice  Click the calendar icon to choose your date ^
	2nd Choice
ORGANIZATION INFORMATION
* Organization Name:
* Official Address of Organization:
* City:
* State:
* Zip:
Click if mailing address is the same as the address above.
* Mailing Name:
* Mailing Address for Check:
* City:
* State:
* Zip:
* Contact Name:
* Daytime Phone Number:
* Contact Email Address:
* How did you hear about our Program?:	Employee
If employee, please provide name:
	Friend
	Website
	Flamingo Fan Club
	Promotional Materials in Restaurant
	Hosted Previous Fundraiser
	Postcard
If postcard, employee name on card:
	Other
If other, please describe:
* Is your organization a non-profit    organization as defined and recognized    by the IRS?:	Yes No
Note: For organizations that do not qualify as a 501(c)3 organization, as recognized    by the IRS, we may require a W-9 form to be completed.
Is there anything else you'd like to share with us about your request?:
If you are experiencing any difficulties completing this form or have any questions, please contact Debra Miller, Community Care Coordinator, at or 717-394-0623, ext. 22.