Hospice Helpers Application

Name of group/organization planning event *
Name of individual(s) in charge of event *
Mailing Address *
City *
State *
Zip *
Email *
Daytime Phone: *
Evening Phone *
Name of event: *
Date/Time of Event: *
Location of event *
Event is: *
Ticket Price: $ *
Table Price: $ *
Has this event taken place before? *
Will this be an annual event? *
Briefly describe the event *
Estimated revenue from event: *
Estimated expenses: *
Estimated contribution to the Hospice Foundation: *
After expenses, what percentage of the net proceeds will go to the Hospice Foundation? *
If the proceeds will be split, please list additional beneficiaries: *
Do you require someone from the Hospice Foundation to speak at your event? *
Will you require any Hospice Volunteers? *
If yes, how many?
Volunteer Shift Times:
Volunteer job description
Do you plan to use the Hospice Foundation logo in any promotional materials? *
Will you require any Hospice brochures? *
If yes, how many?
Will you require the Hospice Foundation banner? *
How will your event be promoted? *
Will you be alerting the media? *
If yes, please list media outlets:
Your Electronic Signature (write name in box) is confirmation that you have read and agreed to the Hospice Helpers Guidelines *
Date: *