Fundraising & Event Registration Form

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Fundraising & Event Registration Form Powered By Docstoc
					Fundraising & Event Registration Form

Thank you for choosing to raise vital funds
for Weston Park Hospital Cancer Charity

Your Details

Title: Mr           First Name:                                 Surname:
Address:
Town:                                                           Postcode:
Home Tel:                                                       Mobile No:
Email:                                                          Date of Birth:

   We would prefer to contact you by email – please tick here if this is NOT convenient

Additional Fundraiser

Title: Mr           First Name:                                 Surname:
Address:
Town:                                                           Postcode:
Home Tel:                                                       Mobile No:
Email:                                                          Date of Birth:

Fundraising / Event Details

Type of fundraising/event:
Date:
Venue name & address (if different from above):
Venue telephone no:
JustGiving address (if applicable):

    Yes, I would like our event details to feature on the WPH Cancer Charity website (tick box)
Is there a special reason why you are supporting Weston Park Hospital Cancer Charity?



Fundraising Materials                                                       Declaration

                                                       Please Tick          By entering my name below I understand and agree that I
                                          Amt
 Fundraising materials                                                      am undertaking this event at my own risk and that Weston
                                          Req   Post     Email Collect      Park Hospital Cancer Charity is not responsible for any
 Sponsorship form                                                           risk, injury or loss that may result, and will not be liable for
                                                                            any claim which may arise from this event.
 Event poster
                                                                            I agree to pay the proceeds from this event to Weston
 WPHCC newsletter                                                           Park Hospital Cancer Charity to support research and
                                                                            improve treatments and care for people living with cancer.
 Balloons (max 5)
                                                                            Name:
 Handheld flags (max 5)
 Collection box                                                             Date:
 (with security chain for pubs, shops
 etc)                                                                       Weston Park Hospital Cancer Charity
 Collection box                                                             Whitham Road, Sheffield, S10 2SJ
 (without security chain for street
 collections, evnts etc)
                                                                            t: 0114 226 5370 f: 0114 226 5372
 Collection bucket                                                          e: cancer.charity@sth.nhs.uk

                                                                            Registered Charity No: 1039885



For official use only:                RE No:                      Fundraiser:

				
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