Volunteer Fundraising Event Form

Primary Contact*

Title

Organization (if applicable)

Mailing Address*

City*

State*

Zip Code*

Phone Number*

E-Mail*

Proposed Event Name*

Nature of Event*

Date(s) and Time(s)*

Location/Venue*

Street Address*

City*

State*

Zip

Is this event open to the public?*

NoYes

Projected Attendance*

Is there a specific hospital, outpatient center, or program your event will benefit?

Have you conducted fundraisers or donated to BHF or its hospitals, outpatient center, or programs in the past?

NoYes

How do you plan to promote this event?

Is BHF the sole beneficiary?*

NoYes

If BHF is not the sole beneficiary, please list other beneficiaries

What are the proposed responsibilities for BHF?

Do you plan to seek sponsorship from businesses or community groups?*

NoYes

If yes, please complete a prospect list and submit for BHF to review and approve. Please confer with BHF before contacting any prospective sponsors. Many local organizations already support BHF in some way and we try to keep overlap to a minimum.

Will a written financial summary be available to BHF?

NoYes

Estimated Total Proceeds*

Expenses (Including costs such as printing, food, entertainment, rentals, etc.*

Anticipated Net Proceeds (proceeds minus expenses)*

Estimated Amount/Percentage of Net Proceeds to be Given to BHF*

This registration form does not authorize the sponsoring individual or organization or any representative of the sponsoring organization to act as an agent of Baystate Health Foundation, Inc., Baystate Health, Inc., or any of their affiliated entities or programs.

I agree that until written permission has been granted, contributions may not be solicited in the name of Baystate Health Foundation, Inc., or its affiliated entities or programs, and these names may not be used for any other purpose. Once final approval has been granted, I agree to adhere to the policies and guidelines provided by Baystate Health Foundation.

By submitting this form, I agree that I've read the and understand all of the policies, guidelines, processes, and procdures outlined on the host your own fundraiser Web page.

Contact Information

Event Information

Event Management

Financial Information