{"id":59,"date":"2025-08-25T18:17:12","date_gmt":"2025-08-25T18:17:12","guid":{"rendered":"https:\/\/casinosalemdev.wpenginepowered.com\/?page_id=59"},"modified":"2025-08-25T18:17:12","modified_gmt":"2025-08-25T18:17:12","slug":"donation-request-form","status":"publish","type":"page","link":"https:\/\/casinosalem.com\/?page_id=59","title":{"rendered":"Donation Request Form"},"content":{"rendered":"<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of 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      <\/div><form method='post' enctype='multipart\/form-data'  id='gform_3'  action='\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F59' data-formid='3' novalidate><div class='gf_invisible ginput_recaptchav3'  data-tabindex='0'><input id=\"input_63df5d1a8538265bf77429563bee652e\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_63df5d1a8538265bf77429563bee652e\" value=\"\"\/><\/div> \r\n <input type='hidden' class='gforms-pum' value='{\"closepopup\":false,\"closedelay\":0,\"openpopup\":false,\"openpopup_id\":0}' \/>\n                        <div class='gform-body gform_body'><div id='gform_fields_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_3_32\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >This request form has two sections:\n<Br><Br>\n<Strong>Section 1<\/Strong> provides us the basic information about your organization and your mission, as well as information on how Rosie\u2019s team members can recognize their partnership in your event or program. <Strong>Section 2<\/Strong> provides details on what type of contribution you are seeking.<\/div><div id=\"field_3_36\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Section 1: Organization Information<\/h3><\/div><div id=\"field_3_4\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_4'>Organization Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_4' id='input_3_4' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_3_3\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Contact Person Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_3_3'>\n                            \n                            <span id='input_3_3_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.3' id='input_3_3_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_3_3_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_3_3_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.6' id='input_3_3_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_3_3_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_3_43\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_43'>Contact Person Title<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_43' id='input_3_43' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_5\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_5'>Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_5' id='input_3_5' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_7\" class=\"gfield gfield--type-email gfield--input-type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_7'>Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_7' id='input_3_7' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_3_6\" class=\"gfield gfield--type-address gfield--input-type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Mailing Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_3_6' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_3_6_1_container' >\n                                        <input type='text' name='input_6.1' id='input_3_6_1' value=''    aria-required='true'    \/>\n                                        <label for='input_3_6_1' id='input_3_6_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_3_6_2_container' >\n                                        <input type='text' name='input_6.2' id='input_3_6_2' value=''     aria-required='false'   \/>\n                                        <label for='input_3_6_2' id='input_3_6_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_3_6_3_container' >\n                                    <input type='text' name='input_6.3' id='input_3_6_3' value=''    aria-required='true'    \/>\n                                    <label for='input_3_6_3' id='input_3_6_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_3_6_4_container' >\n                                        <input type='text' name='input_6.4' id='input_3_6_4' value=''      aria-required='true'    \/>\n                                        <label for='input_3_6_4' id='input_3_6_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_3_6_5_container' >\n                                    <input type='text' name='input_6.5' id='input_3_6_5' value=''    aria-required='true'    \/>\n                                    <label for='input_3_6_5' id='input_3_6_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_6.6' id='input_3_6_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_3_8\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_8'>Under what IRS section do you qualify as a non-profit? (e.g. 501(c)(3))<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_8' id='input_3_8' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_35\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Section 2: Contribution Details<\/h3><div class='gsection_description' id='gfield_description_3_35'>Tell us about your area of need.<\/div><\/div><div id=\"field_3_9\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_9'>Does this event or program support any other community organizations? If yes, please specify<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_9' id='input_3_9' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_3_10\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >At the requested level, how would Rosie\u2019s receive recognition?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_3_10'>(Check all that apply)<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_10'><div class='gchoice gchoice_3_10_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.1' type='checkbox'  value='Banner Space'  id='choice_3_10_1'   aria-describedby=\"gfield_description_3_10\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_3_10_1' id='label_3_10_1' class='gform-field-label gform-field-label--type-inline'>Banner Space<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_10_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.2' type='checkbox'  value='Public Address\/Band Announcements'  id='choice_3_10_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_10_2' id='label_3_10_2' class='gform-field-label gform-field-label--type-inline'>Public Address\/Band Announcements<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_10_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.3' type='checkbox'  value='Included on Event Posters, Flyers'  id='choice_3_10_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_10_3' id='label_3_10_3' class='gform-field-label gform-field-label--type-inline'>Included on Event Posters, Flyers<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_10_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.4' type='checkbox'  value='Included on Event T-shirts'  id='choice_3_10_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_10_4' id='label_3_10_4' class='gform-field-label gform-field-label--type-inline'>Included on Event T-shirts<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_10_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.5' type='checkbox'  value='Logo on Invitations'  id='choice_3_10_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_10_5' id='label_3_10_5' class='gform-field-label gform-field-label--type-inline'>Logo on Invitations<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_10_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.6' type='checkbox'  value='Logo on Paid Ads (Specify Radio, TV, Web or Print)'  id='choice_3_10_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_10_6' id='label_3_10_6' class='gform-field-label gform-field-label--type-inline'>Logo on Paid Ads (Specify Radio, TV, Web or Print)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_10_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.7' type='checkbox'  value='Included in Media Releases'  id='choice_3_10_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_10_7' id='label_3_10_7' class='gform-field-label gform-field-label--type-inline'>Included in Media Releases<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_10_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.8' type='checkbox'  value='Naming Rights (Indicate What Would be Named)'  id='choice_3_10_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_10_8' id='label_3_10_8' class='gform-field-label gform-field-label--type-inline'>Naming Rights (Indicate What Would be Named)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_10_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.9' type='checkbox'  value='Display Booth or Table at Event'  id='choice_3_10_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_10_9' id='label_3_10_9' class='gform-field-label gform-field-label--type-inline'>Display Booth or Table at Event<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_10_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.11' type='checkbox'  value='Other Recognition'  id='choice_3_10_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_10_11' id='label_3_10_11' class='gform-field-label gform-field-label--type-inline'>Other Recognition<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_38\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Select Media For Logo Placement:<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_38'><div class='gchoice gchoice_3_38_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_38.1' type='checkbox'  value='Radio'  id='choice_3_38_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_38_1' id='label_3_38_1' class='gform-field-label gform-field-label--type-inline'>Radio<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_38_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_38.2' type='checkbox'  value='TV'  id='choice_3_38_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_38_2' id='label_3_38_2' class='gform-field-label gform-field-label--type-inline'>TV<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_38_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_38.3' type='checkbox'  value='Web'  id='choice_3_38_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_38_3' id='label_3_38_3' class='gform-field-label gform-field-label--type-inline'>Web<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_38_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_38.4' type='checkbox'  value='Print'  id='choice_3_38_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_38_4' id='label_3_38_4' class='gform-field-label gform-field-label--type-inline'>Print<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_39\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_39'>Naming Rights (Indicate What Would be Named)<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_39' id='input_3_39' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_3_11\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_11'>(Please Specify)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_11' id='input_3_11' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_3_13\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_13'>Event or Project Name:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_13' id='input_3_13' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_14\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_14'>Event Date(s) or Timeline:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_3_14' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_15\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_15'>How many years has the event\/project taken place?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_15' id='input_3_15' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_16\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_16'>What is the scope of event\/project and who does it benefit?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_16' id='input_3_16' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_3_18\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >What is the primary purpose for this event?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_18'>\n\t\t\t<div class='gchoice gchoice_3_18_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='Community Event: Entertainment - FREE'  id='choice_3_18_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_18_0' id='label_3_18_0' class='gform-field-label gform-field-label--type-inline'>Community Event: Entertainment &#8211; FREE<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_18_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='Community Event: Entertainment'  id='choice_3_18_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_18_1' id='label_3_18_1' class='gform-field-label gform-field-label--type-inline'>Community Event: Entertainment<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_18_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='Community Fundraiser'  id='choice_3_18_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_18_2' id='label_3_18_2' class='gform-field-label gform-field-label--type-inline'>Community Fundraiser<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_18_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='Team Fundraiser'  id='choice_3_18_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_18_3' id='label_3_18_3' class='gform-field-label gform-field-label--type-inline'>Team Fundraiser<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_18_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='Dinner, Lunch, Breakfast'  id='choice_3_18_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_18_4' id='label_3_18_4' class='gform-field-label gform-field-label--type-inline'>Dinner, Lunch, Breakfast<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_18_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='Children&#039;s Event'  id='choice_3_18_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_18_5' id='label_3_18_5' class='gform-field-label gform-field-label--type-inline'>Children&#8217;s Event<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_18_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='Performing Arts'  id='choice_3_18_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_18_6' id='label_3_18_6' class='gform-field-label gform-field-label--type-inline'>Performing Arts<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_18_7'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='Educational'  id='choice_3_18_7' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_18_7' id='label_3_18_7' class='gform-field-label gform-field-label--type-inline'>Educational<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_18_8'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='Golf Outing'  id='choice_3_18_8' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_18_8' id='label_3_18_8' class='gform-field-label gform-field-label--type-inline'>Golf Outing<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_18_9'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='Special Project'  id='choice_3_18_9' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_18_9' id='label_3_18_9' class='gform-field-label gform-field-label--type-inline'>Special Project<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_18_10'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='Other'  id='choice_3_18_10' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_18_10' id='label_3_18_10' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_19\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_19'>(Please Specify)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_19' id='input_3_19' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_3_20\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >We need:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_20'><div class='gchoice gchoice_3_20_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.1' type='checkbox'  value='Volunteers'  id='choice_3_20_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_20_1' id='label_3_20_1' class='gform-field-label gform-field-label--type-inline'>Volunteers<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_20_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.2' type='checkbox'  value='Food &amp; Beverage'  id='choice_3_20_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_20_2' id='label_3_20_2' class='gform-field-label gform-field-label--type-inline'>Food &amp; Beverage<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_20_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.3' type='checkbox'  value='Event Planning Assistance'  id='choice_3_20_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_20_3' id='label_3_20_3' class='gform-field-label gform-field-label--type-inline'>Event Planning Assistance<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_20_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.4' type='checkbox'  value='Food and Drink Advice'  id='choice_3_20_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_20_4' id='label_3_20_4' class='gform-field-label gform-field-label--type-inline'>Food and Drink Advice<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_20_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.5' type='checkbox'  value='A Place for the Event'  id='choice_3_20_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_20_5' id='label_3_20_5' class='gform-field-label gform-field-label--type-inline'>A Place for the Event<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_20_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.6' type='checkbox'  value='Cash Donation'  id='choice_3_20_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_20_6' id='label_3_20_6' class='gform-field-label gform-field-label--type-inline'>Cash Donation<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_20_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.7' type='checkbox'  value='Co-sponsorship'  id='choice_3_20_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_20_7' id='label_3_20_7' class='gform-field-label gform-field-label--type-inline'>Co-sponsorship<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_22\" class=\"gfield gfield--type-number gfield--input-type-number gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_22'>Number of Volunteers Needed:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_22' id='input_3_22' type='number' step='any'   value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_3_25\" class=\"gfield gfield--type-number gfield--input-type-number gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_25'>Food &amp; Beverage for how many people?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_25' id='input_3_25' type='number' step='any'   value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_3_26\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_26'>What kind of food &amp; drink?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_26' id='input_3_26' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_3_27\" class=\"gfield gfield--type-number gfield--input-type-number gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_27'>Cash Donation Requested<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_27' id='input_3_27' type='text' step='any'   value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_3_28\" class=\"gfield gfield--type-number gfield--input-type-number gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_28'>Co-sponsorship Donation Requested<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_28' id='input_3_28' type='text' step='any'   value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_3_29\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_29'>Please tell us how we can help with your event, organization or both?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_29' id='input_3_29' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_3_41\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_3_41'>IRS Form W-9 Attachment<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_3_41'><div style=\"font-size: 15px\">Please attach your IRS Form W-9 to fully evaluate your request.\n<\/div><\/div><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_3_41' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_3_41&quot;,&quot;container&quot;:&quot;gform_multifile_upload_3_41&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_3_41&quot;,&quot;filelist&quot;:&quot;gform_preview_3_41&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/casinosalem.com\\\/?gf_page=df3cd9af7573041&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/casinosalem.com\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/casinosalem.com\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;pdf&quot;}],&quot;max_file_size&quot;:&quot;52428800b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:3,&quot;field_id&quot;:41},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_3_41&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_3_41' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_3_41' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_3_41 gfield_description_3_41\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_3_41'>Accepted file types: pdf, Max. file size: 50 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_3_41'><\/ul> <!-- Leave <ul> empty to support CSS :empty selector. --><\/div><div id='gform_preview_3_41' class='ginput_preview_list'><\/div><\/div><div id=\"field_3_46\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_3_46'>IRS 501(c)(3) Letter of Determination Attachment<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_3_46'><div style=\"font-size: 15px\">Please attach yourIRS 501(c)(3) Letter of Determination to fully evaluate your request.\n<\/div><\/div><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_3_46' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_3_46&quot;,&quot;container&quot;:&quot;gform_multifile_upload_3_46&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_3_46&quot;,&quot;filelist&quot;:&quot;gform_preview_3_46&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/casinosalem.com\\\/?gf_page=df3cd9af7573041&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/casinosalem.com\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/casinosalem.com\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;pdf&quot;}],&quot;max_file_size&quot;:&quot;52428800b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:3,&quot;field_id&quot;:46},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_3_46&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_3_46' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_3_46' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_3_46 gfield_description_3_46\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_3_46'>Accepted file types: pdf, Max. file size: 50 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_3_46'><\/ul> <!-- Leave <ul> empty to support CSS :empty selector. --><\/div><div id='gform_preview_3_46' class='ginput_preview_list'><\/div><\/div><div id=\"field_3_31\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_31'>Other Attachments<\/label><div class='gfield_description' id='gfield_description_3_31'><div style=\"font-size: 15px\">Please attach the organization&#8217;s mission statement, a list of sponsorship levels, if applicable, and any additional explanations to questions on this application if necessary. Complete a separate form for each request.<\/div><\/div><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='52428800' \/><input name='input_31' id='input_3_31' type='file' class='medium' aria-describedby=\"gfield_upload_rules_3_31 gfield_description_3_31\" onchange='javascript:gformValidateFileSize( this, 52428800 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_3_31'>Accepted file types: pdf, Max. file size: 50 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_3_31'><\/div><\/div><\/div><div id=\"field_3_30\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><Strong>Completed form should be submitted on or before the dates below:<\/Strong>\n<BR>\nEvents within these months: <BR>\nOctober, November, December due by 5PM on August 15<BR>\nJanuary, February, March due by 5PM on November 15<BR>\nApril, May, June due by 5PM on February 15<BR>\nJuly, August, September due by 5PM on May 15<BR><\/div><fieldset id=\"field_3_42\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Terms &amp; Conditions<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_3_42'><div style=\"font-size: 15px\">Review the terms and conditions associated with receipt of the requested donation by clicking <a target=\"_blank\" href=\"https:\/\/rosiesgaming.com\/donation-terms-and-conditions\/\"><u>HERE.<\/u><\/a><\/div><\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_42'><div class='gchoice gchoice_3_42_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.1' type='checkbox'  value='I have read and agree to the Terms and Conditions.'  id='choice_3_42_1'   aria-describedby=\"gfield_description_3_42\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_3_42_1' id='label_3_42_1' class='gform-field-label gform-field-label--type-inline'>I have read and agree to the Terms and Conditions.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_33\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_33'>Signature and Title of Requesting Organization Representative:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_33' id='input_3_33' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_47\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_47'>Email<\/label><div class='ginput_container'><input name='input_47' id='input_3_47' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_3_47'>This field is for validation purposes and should be left unchanged.<\/div><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_3' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='SUBMIT'  \/> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_3' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_3' id='gform_theme_3' value='orbital' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_3' id='gform_style_settings_3' value='{&quot;inputPrimaryColor&quot;:&quot;#204ce5&quot;}' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_3' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='3' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' 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