SIGN UP HERE TO BE A TOWN THEATRE PARTNER.

 

The undersigned acknowledges on behalf of the youth organization identified below the following requirements for receipt of a portion of the net profits generated by the Chillicothe Optimist Club’s operation of the Town Theatre:

          1.       Only charitable, not-for-profit and tax supported entities with programs designed to exclusively benefit youth are eligible for the receipt of a portion of the Chillicothe Optimist Club’s net profit generated by the operation of the Town Theatre.  The Town Theatre committee of the Chillicothe Optimist Club shall make the determination of eligibility in its sole discretion.

          2.       This application must be properly completed and submitted to the staff of the Town Theatre on or before February 1st effective 2011 to be eligible for participation in this program.

          3.       All applicants will receive notice of approval or disapproval prior to the annual Kids Count Nite which shall occur after February 1^st and prior to the third Saturday in March each year.

          4.       Any inquiries by members of the Town Theatre Committee for more information from the applicant must be responded to in a timely manner no later than 14 days from the date of any such inquiry or else the application will be deemed withdrawn.

          5.       The distribution of net profits will be based entirely upon the Optimist Club’s announcement of the net profit available for distribution each year divided by the total number of tickets turned in by eligible youth organizations to arrive at the net profit per ticket to be distributed to each pre-qualified youth organization.

 

 PLEASE ANSWER THE FOLLOWING QUESTIONS TO VERIFY YOUR YOUTH ORGANIZATION'S ELIGIBILITY...

 

I.  Name and description of your organization, the number of years in existence, and a brief description of the youth- related  goals of your organization:_________________________________________________                                                                                ________________________________________________________________

________________________________________________________________________________________________________________                                                                                                         ________________________________________________________________

________________________________________________________________________________________________________________

                                                                                                          ___________________________________________________________

 

II.      Description of any new or existing youth programs that may benefit from the financial assistance of the Chillicothe Optimist Club:

                                                                                                                    _____________________________________________________

                                                                                                                    _____________________________________________________

                                                                                                                    _____________________________________________________

                                                                                                                     _____________________________________________________

 

III.     How many youths will be served by your youth program and how will the youths benefit from your program?

                                                                                                                  ______________________________________________________  _________________________________________________

___________________________________________________________________________________

         ____                                                                                      ____________________________________________________________

                                                                                                                    ______________________________________________________

 

 

IV.     Who in your organization should we communicate with regarding our processing of your application?

 

          Name/Phone Number:

                                                                                                          _____________________________________________________

          Mailing Address:

                                                                                                         

                                                                                                         

          E-Mail Address:

                                                                                                         

 

 

 

 

        The undersigned on behalf of                                                            does hereby state that the applicant meets all of the requirements listed above and agrees to abide by all of the terms and conditions as recited above.

 

 

                                                                               ____    DATE                                                                           

          Signature of Representative

          of above-named organization

 

 

V.      Please provide a reference to verify any of the above information.

 

          Name/Phone Number:

                                                                                                         

          Mailing Address:

                                                                                                         

                                                                                                         

          Dated                                              _________

 

PRE-QUALIFICATION APPLICATION

APPLICATION FOR PARTNERSHIP