Community Fundraising Proposal Agreement
Thank you for supporting Wishlist and your interest in fundraising! Before you begin organising your fundraising event, please complete and return this form. We will contact youpromptly to confirm we have received your proposal and are happy for you to proceed. Please fill in as much information as you can or write N/A if not applicable.
1. Fundraiser/Event Coordinator
Title: ______
Name and Surname: ______
Organisation / Company Name: ______
Address:______Postcode: ______
Phone: ______ (mob):______
Fax: ______Email: ______
Website (if applicable):
Position with Company/Organisation: ______
Have you raised funds for Wishlist before? No Yes (Please give details):
______
What inspired you to raise funds for Wishlist? ______
Name of one personal referee: ______
Address: ______Postcode:______
Relationship:______Phone:______
Email: ______
Fundraiser/Event
Name of proposed fundraiser/event: ______
______
Proposed date/timeframe of your fundraising event: ______
Address/venue of fundraising event: ______
Tell us briefly about your fundraising event (plan, number of people attending, how funds will be raised, etc.):______
______
How do you plan to promote your fundraiser / event? ____________
______
Do you hope to haveWishlist assist with promoting your event? No Yes
If yes, how?______
______
Do you have or intend to seek public liability insurance for your event? No Yes
Please give details: ______
______
Administration
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Do you require Wishlist to auspice income and expenses for the event? No Yes
Do you require Wishlist to produce tax-deductible receipts? No Yes
Do you require raffle books from Wishlist? No Yes
Are there any resources you need from Wishlist to make your fundraising event a success? Please tick:
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Advice / Planning assistance
Online registration & payment via Wishlist website
Signage
Donation tins
Brochures / Literature
Raffle tickets
Receipt Books
Publicity (Press releases, promos, etc.)
Wishlist representative/s
Other (please specify):
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______
______
Do you want to use Wishlist’s logo? □ No □ Yes
(Please give details)______
Do you plan to hold your own fundraising events for Wishlist on an ongoing basis? □ No □ Yes
(If yes, please give details)______
______
Sponsors
Please include information about sponsorsyou have secured or want to approach to ensure there is no conflict with our health policies and/or current sponsorship arrangements.
Have you secured sponsors for the event? □ No □ Yes
If yes, who? ______
______
Do you intend to approach potential sponsors for the event? □ No □ Yes
If yes, who? ______
______
Fundraiser/Event Budget
How much do you hope to raise? $______
Proposed Expenditure: $______
Anticipated total income:$______
*If possible please provide a list of anticipated expenses and income from the event. Depending on our level of involvement this helps us determine whether to input-tax credit your event (ie. charge GST on tickets/registrations etc.)
Will another organisation benefit from the fundraising? No Yes
If yes, please state the name of the organisation and percentage of funds they will receive: ______%
Wishlistcan direct your donation to any specific hospital (Gympie, Nambour, Caloundra & Maleny) or area / wardwithin our local public health system. Do you want to specify where to direct the funds raised from this event? No Yes
If yes, please state (eg: Children’s Ward or Cancer Centre):______
______
Disclaimer and Fundraising Agreement
Wishlist reserves its right to withdraw its approval for the Fundraiser/event at any time if it appears that there is a likelihood of the Fundraiser failing to adhere to any of the above terms and conditions. In consideration of my application being accepted, I understand, intending to be legally bound for myself and my heirs, executor and administrators, waive and release the organisers and sponsors (individually and collectively), including the directors, officers, staff, volunteers and representatives thereof, and indemnify them against any liability (including liability for negligence) for the death or any physical or mental illness, incapacity or property damage or loss which I may suffer which may directly or indirectly result from my participation in the event/fundraiser. I further verify that I am in proper physical and mental condition to participate in the fundraiser and acknowledge that I am aware of the risks involved and voluntarily agree to assume those risks.
1. I ______
(Coordinator’s name) accept the terms and conditions of the Fundraising Guidelines.
2. I agree to conduct my fundraiser/event ______
(Nameof fundraiser/event) in accordance with those terms and conditions and in a manner, which upholds the integrity, professionalism and ethos of Wishlist.
3. I have read and I agree to abide by the fundraising rules and guidelines of Wishlistand indemnify Wishlist from and against any claims for injuries or damage arising at or from the event/fundraiser that is the subject of this application.
�Feedback on your experience as a Community Fundraiser is important to help us continue to improve and develop this program, and we would welcome the opportunity to get your comments after your fundraiser/event. If you would prefer not to be contacted for this research, please tick this box.
Signature: ______
Name (please print): ______Date: ______
Thank you for supporting Wishlist! Please copy this agreement and keep a record for yourself. Post, email or fax the completed Community Fundraising Proposal & Agreement form to Wishlist:
Post:
Wishlist
P.O. Box 2610
NAMBOUR WEST QLD 4560
Email:
Email:
Fax:
Fax: 07 5470 6362
Contact:
Ph: 07 5470 6598
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