Mini-Meetup Grant - AMCSI: Supporting the Arthrogryposis Multiplex Congenita Community

Name

Phone

Address

Address 2

City

State

Zip

I am a (check one)

Parent Sibling Grandparent Adult with AMC

Are you a member of AMCSI?

Yes No

About The Event

Location

Date

How many AMCSI families do you expect to attand?

How many non-AMCSI families do you expect to attand?

Has there been a regional event before? (check one)

Yes No

If yes, how many Adults?

If yes, how many Children?

Expenses

Has there been a regional event before? (check one)

Yes No

Is there a facility rental fee? (check one)

Yes No

What is the fee?

Cost of food?

Other Costs? (Please list)

Revenue

Will you collect donations from attendees to help cover costs?

Yes No

(If yes, please list)

By signing below, I understand the funding guidelines and agree to them. By accepting an event donation from Arthrogryposis Multiplex Congenita Support, Inc (AMCSI), I understand that AMCSI is not sponsoring this event. I hereby release and forever discharge AMCSI, and its Board of Directors from any and all liability in regards to this event. I further agree that if, despite this Release and Waiver of Liability, I or any person in attendance makes a claim against AMCSI, and its Board of Directors, I will indemnify, save and hold harmless Arthrogryposis Multiplex Congenita Support, Inc., and its Board of Directors from any monetary losses including, but not limited to, legal fees and litigation costs. This release is binding on my heirs, executors, assigns, and administrators. (If you choose to submit this electronically via email, typing your name constitutes a signature and agreement to the above terms.)

Signature

Date

Funding will be made available based upon approval by the Board of Directors of Arthrogryposis Multiplex Congenita Support, Inc. (AMCSI) and the availability of funds. The person(s) applying for this grant must be a paid members of AMCSI. AMCSI will reimburse the applicant by check, within 60 days after the submission of the original receipts. This grant may be used for food, non-alcoholic beverages, and facility rentals. The MAXIMUM grant total is $100.00. The grant application must be submitted at least 90 days prior to the meet-up by either mailing AMCSI at P.O. Box 6291, Spartanburg, SC 29304, or by filling out this online application.

Mini Meetup Grant

Mini Meetup Grant Application Form

All (required) (*) documents must be sent to info@amcsupport.org

Instagram