Community Fundraiser Application

Application to Host an Event

Sponsoring organization:

Contact Person:

Address:

Apt/Suite:

City:

State:

N/A AL AK AB AZ AR BC CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NB NH NJ NM NY NL NC ND NT NS OH OK ON OR PA PE PR QC RI SK SC SD TN TX UK UT VT VI VA WA WV WI WY YT

Zip:

Phone: *

Email: *

EVENT INFORMATION

Event Name: *

When naming the event, please list the event name followed by "benefitting Hospice of the Valley" or "to benefit Hospice of the Valley," such as, "The Smith Family Car Wash, benefitting Hospice of the Valley."

Date(s) and time(s): *

Location(s): *

Estimated attendance: *

Brief description and details of event. Is this an annual event? If so, how many years have you hosted the event? *

Please describe method of raising funds (including sponsorships, fee charges, donations): *

EVENT PUBLICITY

Will you be advertising or publicizing this activity? *

Yes
No

Use of Hospice of the Valley's logo is not permitted on event promotional material, including webpages.

Advertising/Publicity Contact Person:

Phone:

Email:

Please list any websites or social media where you will be publicizing this event:

Describe you expectations for the representative. We will make every effort to provide a representative when requested.

How can Hospice of the Valley assist you with your event?

FUNDRAISING GOAL

Anticipated total donation amount:

Amount/Percentage of proceeds to benefit HOV:

All promotional material must clearly state the percentage of proceeds that will be donated to Hospice of the Valley, if less than 100%.

If there are other beneficiaries besides Hospice of the Valley, please list the organization(s):

Anticipated date of your donation:

Proceeds should be delivered to Hospice of the Valley within 30 days of the conclusion of the event.

Verify Identity *