Wiki_QA__##

This page is read only. You can view the source, but not change it. Ask your administrator if you think this is wrong.
Title: Event Request Form to Edit

Original CoS Document (slug): [[https://conventionofstates.com/files/event-request-form-to-edit|event-request-form-to-edit]]

Login Required to view? No

Attached File: Event_Payment_Request_Form_02062020_(fillable).pdf

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

Created: 2018-10-23 09:55:56

Updated: 2021-06-21 12:39:08

Published: 2018-10-23 09:56:39

Converted: 2025-04-14T19:32:42.452804509


----


{{:cb_mirror_public:media:files_7255_pdfto001.png?nolink&918x1188 |background image}}
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 



{{:cb_mirror_public:media:files_7255_pdfto002.png?nolink&918x1188 |background image}}
 

 

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: 

 

%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%%%__%%_