| Fundraiser/Event Coordinator Details |
Name of Organisation (if applicable):
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| Name of Personal Referee : |
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Address: |
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| Name of Fundraiser/Event:
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| Proposed date/Timeframe of your Fundraiser/Event:
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| Address/Venue of Fundraiser/Event:
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Tell us about your fundraiser/event (plan, number of people attending, how funds will be raised etc:
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How do you intend to promote your event?
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Do have or intend to seek public liability insurance for your event?
No
Yes (please give details)
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| How much Money do you aim to raise for The Cancer Council NT?
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Will another organisation benefit from the fundraising?
No
Yes (If yes, please state which organisation & approx % of funds)
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Proposed Expenditure:
Description:
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Amount:
Total
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Anticipated Income:
Description
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Amount
Total
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| Representing The Cancer Council NT |
What is your motivation to raise funds for The Cancer Council NT?
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Have you ever raised funds for the Cancer Council NT before?
No
Yes (please give details)
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Do you want to use the Cancer Council NT logo? (please see Guidelines)
No
Yes (please give details)
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Do you plan to hold your own fundraising events for The Cancer Council NT on an ongoing basis?
No
Yes (please give details)
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Names of sponsors (both secured and ones you intend to approach, to ensure there is no conflict with our health policies and/or current sponsorship arrangements).
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| Disclaimer and Fundraising Agreement |
The Cancer Council reserves its rights to withdraw its approval for the Fundraiser/event at any time if it appears 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, mental illness, incapacity of 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.
- I
(Coordinator’s name) accept the terms and conditions of the Fundraising Guidelines.
- I agree to conduct my fundraiser/event
(name of fundraiser/event) in accordance with those terms and conditions and in a manner which upholds the integrity, professionalism and ethos of The Cancer Council NT.
- I have read and I agree to abide by the fundraising rules and guidelines of The Cancer Council NT and indemnify The Cancer Council NT from and against any claims for injuries or damage arising 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.
Name (please print):
Date:
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