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Hospice Helpers Application
Name of Organization or Group
Name of Individual(s) in charge
*
Mailing Address (city, state, zip code)
*
Email
*
Phone Number
*
Name of Event
Date & Time of Event
Location of Event
Event is
Open to Public
Invitation Only
Ticket Price
Has this event taken place before?
*
Yes
No
Will this be an annual event?
*
Yes
No
Possibly
Briefly describe the event
*
Estimated revenue from event
*
Estimated expenses
*
Estimated contribution to 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?
*
Yes
No
Will you require any Hospice Volunteers?
Yes
No
If yes, how many?
Volunteer shift times
Volunteer job description
Do you plan to use the Hospice Foundation logo in any promotional materials?
*
Yes
No
Will you require any Hospice brochures?
*
Yes
No
If yes, how many?
Will you require any Hospice brochures?
Yes
No
How will your event be promoted?
Will you be alerting the media?
Yes
No
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
*
Month
January
February
March
April
May
June
July
August
September
October
November
December
Day
1
2
3
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31
Year
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
You will be notified upon approval. Thank you!