Wiki_QA_PREVIEW__@@

This page is read only. You can view the source, but not change it. Ask your administrator if you think this is wrong.
To view this on the COS website, click here [[https://conventionofstates.com/files/event-request-form-to-edit|event-request-form-to-edit]]

To download the pdf file from the COS website, click here [[https://conventionofstates.com/files/event-request-form-to-edit/download|Event_Payment_Request_Form_02062020_(fillable).pdf]]


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====== Event Request Form to Edit ======


This file must be submitted with the State Director's permission with at least 3 weeks notice of the need for remittance.

Attachment: 2309/Event_Payment_Request_Form_02062020_(fillable).pdf
| \\ \\ \\ \\ {{:public:cb_mirror:files_7255_pdfto001.png?nolink&918x1188|}}\\ \\ 1 of 2\\ \\  \\ \\ Rev. 2/6/2020 \\ \\ **EVENT PAYMENT REQUEST FORM**\\ \\ //**(Submit this completed form to **//\\ \\ //**payment@cosaction.com**//\\ \\ //** **//\\ \\ //**at least 21 days before payment is due**//\\ \\ //) //\\ \\ //State laws limit our ability to reimburse volunteers in some states. Please obtain approval for your event before //\\ \\ //incurring any expenses and requesting reimbursement. //\\ \\ **Event Information**\\ \\ ** **\\ \\ Your Information:  Name: %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%_  State: %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%  Position: %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%% \\ \\ Email:  %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%_   Phone: %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%  Date: %%__%%%%__%%%%__%%%%__%%%%__%%%%__%% \\ \\ My COSA State Director is: %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%% \\ \\ ☐\\ \\ I discussed this event with my State Director, and he or she approves of this payment request.\\ \\ Has this event been done before & approved in the past?  \\ \\ ☐\\ \\  Yes   \\ \\ ☐\\ \\  No.  When? %%__%%%%__%%%%__%%%%__%%%%__%%%%__%% \\ \\ Event Name: \\ \\ %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%% \\ \\ Event Host: \\ \\ %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%% \\ \\ Event Description:  %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%% \\ \\ %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%% \\ \\ %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%% \\ \\ Event Details: \\ \\ Event Date: %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%_  City, State: %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%_  Est. Attendance: %%__%%%%__%%%%__%%%%__%%%%__%% \\ \\ Total Cost: %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%  Have you requested a non-profit discount?   \\ \\ ☐\\ \\  Yes   \\ \\ ☐\\ \\  No \\ \\ Check all goals \\ \\ that apply: \\ \\ ☐\\ \\ Recruit volunteers/leaders\\ \\ ☐\\ \\ Lobby Day at State Capitol \\ \\ ☐\\ \\    Respond to Opposition\\ \\ ☐\\ \\ Educate public / seminar\\ \\ ☐\\ \\ Meet with state legislators\\ \\ ☐\\ \\ Conduct Simulated COS\\ \\ ☐\\ \\ Host booth at event\\ \\ ☐\\ \\ Collect petition signatures\\ \\ ☐\\ \\ Other: %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%\\ \\ Have you secured the necessary volunteer support for the event to be successful?  \\ \\ ☐\\ \\  Yes   \\ \\ ☐\\ \\  No \\ \\ If you will be collecting petition signatures, what is your goal amount? %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%% \\ \\ Will you be submitting a request for print materials to distribute at this event?     \\ \\ ☐\\ \\  Yes   \\ \\ ☐\\ \\  No \\ \\ //Print Media Order Form is available online at//\\ \\  \\ \\ https:%%//%%conventionofstates.com/printorders\\ \\  \\ \\  \\ \\ Anticipated Non- \\ \\ COS Dignitaries: \\ \\ %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%% \\ \\ Lobbying: \\ \\ Will this event involve volunteers communicating with legislators or their staff? \\ \\ ☐\\ \\  Yes   \\ \\ ☐\\ \\  No \\ \\ Will volunteers collect petition signatures or ask citizens to contact legislators? \\ \\ ☐\\ \\  Yes   \\ \\ ☐\\ \\  No \\ \\ \\ \\ {{:public:cb_mirror:files_7255_pdfto002.png?nolink&918x1188|}}\\ \\  \\ \\  \\ \\ 2 of 2\\ \\  \\ \\ // //\\ \\  \\ \\ Rev. 2/6/2020 \\ \\  \\ \\  \\ \\  \\ \\ **Itemized Budget **\\ \\ Cost: \\ \\  \\ \\ Item for Purchase: \\ \\ $ %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%_  %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%% \\ \\  \\ \\ $ %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%_  %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%% \\ \\  \\ \\ $ %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%_  %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%% \\ \\  \\ \\ $ %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%_  %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%% \\ \\  \\ \\ $ %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%_ \\ \\  \\ \\ %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%% \\ \\  \\ \\ **Payment Information **\\ \\  \\ \\ Type of Payment: \\ \\  \\ \\ ☐\\ \\    Credit Card (preferred) \\ \\  \\ \\ ☐\\ \\    Check \\ \\  \\ \\ ☐\\ \\    Wire Transfer \\ \\ ☐\\ \\  Other: %%__%%%%__%%%%__%%%%__%%%%__%%_ \\ \\  \\ \\ Payment Contact: \\ \\  \\ \\ Name: %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%_ \\ \\  \\ \\ Email: %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%_\\ \\  \\ \\  \\ \\  \\ \\ Phone: %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%_ \\ \\ Address: \\ \\  \\ \\ %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%% \\ \\ Payment Deadline \\ \\  \\ \\ %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%% \\ \\ **Insurance Information **\\ \\ //(If the event requires insurance, please complete this section and //\\ \\ //attach a copy of the event contract//\\ \\ //.) //\\ \\ // //\\ \\ Venue Name: \\ \\  \\ \\ %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%_  Date Insurance Needed:  %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%% \\ \\ Venue Address: \\ \\  \\ \\ %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%% \\ \\ Venue Contact: \\ \\  \\ \\ Name: %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%_  Email: %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%_  Phone: %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%_ \\ \\ **Additional Information **\\ \\ ** **\\ \\ //(Please provide additional information that would be helpful for COSA to consider in approving this event) //\\ \\ // //\\ \\ %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%_ \\ \\ // //\\ \\ //%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%_ //\\ \\ // //\\ \\ //%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%_ //\\ \\ //   //\\ \\ //%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%_ //\\ \\ // //\\ \\ // //\\ \\ **COSA Office Use Only **\\ \\  \\ \\ Date Received \\ \\  \\ \\  \\ \\ %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%_ \\ \\  \\ \\ This request was submitted:  \\ \\ ☐\\ \\  On-Time   \\ \\ ☐\\ \\  Late \\ \\ Date Approved \\ \\  \\ \\ RD: %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%_  Legal: %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%_  Exec.: %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%_ \\ \\ Date of Payment \\ \\ %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%_ \\ \\  \\ \\  \\ \\  \\ \\ Date PEQ Rec’d: \\ \\  \\ \\ %%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%_   \\ \\  \\ \\ |
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|  __Page Metadata__  ||
|Login Required to view?  |No                  |
|Created:                 |2018-10-23 13:55 GMT|
|Updated:                 |2021-06-21 16:39 GMT|
|Published:               |2018-10-23 13:56 GMT|
|Converted:               |2025-11-11 12:12 GMT|
|Change Author:           |Joanne Laufenberg   |
|Credit Author:           |                    |