Gateway GIVES - Donation Application Form

Name of organization:

Is this a registered charitable organization: YES NO

If YES, please provide proof of registration or non-profit status:

Contact Name:

Title:

Contact Phone Number:

Contact Email:

Mailing Address of the organization:

Phone Number:

Website (if applicable):

Please indicate what you are requesting:

DONATION SPONSORSHIP SILENT AUCTION ITEM

Please specify the amount being requested: Have you received a donation from Gateway Casinos & Entertainment Limited or any of its properties in the past?

YES NO

If YES, please mark the Gateway property that supported you:  Grand Villa Casino – , BC  Lake City Casino – , BC  Starlight Casino – , BC  Chances Mission – Mission, BC  Cascades Casino Resort – Langley, BC  Chances Squamish – Squamish, BC  Lake City Casino – Vernon, BC  Newton Community Gaming Centre – Surrey, BC  Lake City Casino – , BC  Palace Casino – Edmonton, AB  Lake City Casino – , BC  Baccarat Casino – Edmonton, AB  Corporate Head Office – Burnaby, BC

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What did you receive:

Please briefly describe the organization:

Please provide a brief description of the event/program you are seeking support for:

Please submit the completed sponsorship –Donation form together with any additional information you wish to provide to: [email protected]

Applications must be submitted no less than 90 days prior to event. All requests are reviewed by the committee on a monthly basis. You will be notified of their decision within 30 days of your submission.

Thank you for your application.

Gateway Casino & Entertainment Limited - 4621 Canada Way, Suite 300 Burnaby, BC V5G 4X8- www.gatewaycasinos.com - (604) 412-0166 Page | 2