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Autograph/Memorabilia Donation Request Form
This form, when signed by the promotional agency involved and approved by the Creighton University Athletics Department, allows a student-athlete's name, picture or identity to be used in a community service or promotional activity and/or permits the institution to provide a donation to the requesting organization provided that the organization agrees to the required terms outlined below:

Required Fields in Bold
NCAA Bylaw 12.5.1.1 permits a charitable or educational group to use a student-athlete's name, picture or appearance to support a charitable event, provided all of the following conditions are met:




a. The student-athlete receives prior written approval from the athletic director or designee;




b. The student-athlete does not miss class;




c. All money derived from the activity go directly to the member institution or charitable/educational agency;




d. The student-athlete's name or picture is not used to promote the commercial ventures of any non-profit or for-profit agency;




e. The name or picture of a student-athlete may not appear on any printed promotional items that include a reproduction of a product with which a commercial entity is associated if the entity's officially registered trademark or logo also appears on the item;




f. The specific activity or project does not involve co-sponsorship, advertisement or promotion by a commercial agency other than through the reproduction of the sponsoring company's officially registered regular trademark or logo on printed materials such as pictures, posters or calendars;




g. The student-athlete may accept legitimate and normal expenses from the member institution, conference, or the charitable, educational or nonprofit agency related to participation in such activity, provided it occurs within the state or, if outside the state, within a 100-mile radius of campus;




h. The student-athlete and an authorized representative of the charitable or educational agency sign a release statement that ensures that the student-athlete's name, image or appearance is used in a manner consistent with the requirements of this section.

i. The autographed item is not sold for the recipient¿s personal gain or profit.
 
To be completed by the requesting group/agency:
Name of requesting organization:
 
Event/organization website:
Group/Organization Description:
 
High School
Middle School
Elementary School
Charitable Group [You will be asked to proivde proof of 501(c) (3) status]
Church
Business
Personal
Other (please explain below)
If you selected other above, please explain:
 
Name/Title of person completing this form:
 
Contact e-mail address:
 
Mailiing Address (Street, City, State, Zip Code):
 
Phone Number:
 
Name of Event:
 
Date of Event:
 
Do you have a flyer or letter describing this event?
 
Please provide a link(s) where we could find that information in the box below. If that is not possible, please copy & paste text into box below:
 
Has Creighton Athletics donated an item(s) to your group/organization in the past? If so, what and when?
 
Please note Creighton's general policy: autographed items provided by CU will be charged as follows: Team Men's Basketball $50, Team Women's Basketball $25, Team Men's Soccer Ball $50, Team Women's Soccer Ball $25, Team Signed Baseball $25. These charges may be waived if you provide the item to be autographed, as long as your organization does not directly benefit prospective student-athletes, and otherwise complies with all other NCAA regulations.
I will provide item.
 
I would like Creighton Athletics to provide the item.
 
Please choose an item(s) to be donated by Creighton Athletics:
 
Autographed Basketball (MBB Team)
Autographed Basketball (WBB Team)
Autographed Soccer Ball (Men's Soccer Team)
Autographed Soccer Ball (Women's Soccer Team)
Autographed Baseball (Team)
Other (Please describe below)
If you selected other above, please specify:
 
 
Please answer the following questions:
Is this a fundraising event?
 
Will the event involve any commercial agencies or sponsors (e.g. First National Bank)?
 
If you selected yes above, please provide a detailed description of the role of the sponsor:
 
Will the funds directly or indirectly benefit a group?
 
If yes to the answer above, please describe:
 
Will the funds directly or indirectly benefit an individual?
 
If yes to the answer above, is that individual a high school student?
 
Will funds raised from the event benefit students that are either, 7th/ 8th grade males or 9th-12th grade males and females?
 
Will the money raised go directly to a charity?
 
If yes to question above, please list name of charity:
 
What is the age range of the individuals who will benefit from the fundraiser/donated items?
 
1 year old - 6th grade
7th-8th grade males
9th-12 grade males or females
Non-student, age 18+
 
If you checked "7th - 8th grade males" because your organization involves kids grades kindergarten through 8th grade, do you agree that the funds raised by this donation will only be used for 6th graders and below?
 
Yes
No
Any additional questions?
 
 
By typing my name below, I certify that I have read the regulations listed above and have completed the form to the best of my knowledge. I agree to comply with the required terms of NCAA Bylaw 12.5.1.1.
Name:
 
Date:
 
Should your request be approved, you will be contacted within five business days to set up payment (if necessary) and have your order fulfilled.
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