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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