Event Title:

Event Date(s):

LDP Sponsorship Amount:

Total Event Expenses:

Use of Funds Acknowledgement – Select Appropriate Response:

Option 1: I certify that all funds were used for the above event.
Option 2: All funds were not used for the above event, and I agree to return the unused funds to LDP within 90 days of the event date.

By clicking the box below, I agree to provide additional documentation, if requested.

I agree.

Name of Organization Representative:

Title:

Email:

Today’s Date:

By clicking the box below, I hereby certify that the information provided herein is true and accurate.

I certify.