Fundraising Activity / Event Application Form

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Contact Information

First Name

Last Name

Are you representing an organisation or group?

YesNo

Name

Street Address

Suburb	State
Postcode	Country

Phone

Proposed Activity / Event Details

Name of proposed activity / event

Date

Time

Location

Please provide a brief description of the activity / event and how funds will be raised

Please briefly describe your target audience/who will be attending your event

Expected Attendance

Will you be approaching any organisation for Sponsorship? Please list them below

Would you like funds raised to be allocated to a specific ward / unit / department / program within Monash Health?

YesNo

Where?

Will the proceeds be shared with another not-for-profit organisation?

YesNo

Contact Details

Percentage allocated to Monash Health

Will a raffle be held as part of this activity / event?

YesNo

Total value of prizes

Please refer to Victorian Gambling Licensing Authority – Raffle Guidelines.

Supporting Information

Please provide any additional information about your fundraising activity / event

Fundraising Activity / Event Proposed Budget

	Income ($)
Sponsorship
Registration Fees
Ticket Sales
Donations
Other
Total

	Expenses ($)
Venue Hire
Food & Beverage
Promotional Material
Printing
Prizes
Other
Total
Total Profit

In Kind Support

Please provide the organisation name and description of goods/services provided

Terms and Conditions

All paperwork and funds raised will be returned to the Monash Health Foundation within 30 days of the completion of the activity / event

All promotional material and publicity must be approved by Monash Health Foundation prior to release

By ticking this box you agree to the terms and conditions above

I agree

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Contact Information