Le Bonheur Children's Medical Center. Special Event and Fundraising Application/Agreement

Transcription

1 Le Bonheur Children's Medical Center Special Event and Fundraising Application/Agreement Any persons and/or organizations desiring to conduct an event or promotion that involves the use of the name "Le Bonheur Children's Medical Center" for fundraising and/or publicity efforts must complete this Application/Agreement and receive written approval from Development in advance of beginning any such fundraising or publicity efforts. Fax or mail the completed Application/Agreement to: Le Bonheur Children's Medical Center P. O. Box Memphis, TN Fax: (901) If any assistance is needed in the process of completing this Application/Agreement, please contact the Foundation at (901) Thank you for your interest and cooperation!

2 Application/Agreement Le Bonheur Fundraiser Name of Individual, Business, School, Group, or Organization: Description of Type of Business, Organization, etc. Contact Person for this Fundraiser: Mailing and Street Address: Day Phone: Evening Phone: Fax: 1. Briefly describe the fundraiser you would like to organize, including the date/time you would like to do it. (If you would like a list of fundraising ideas, please let us know.) 2. Suggested name of fundraiser (if any): 3. Length of fundraiser (please be specific, provide dates): 4. Location of fundraiser:

3 5. Please list below any and all categories and amounts of revenue you expect to receive and their sources. Category Amount each Quantity Total Source Examples: T-shirts $5 per shirt 100 $500 From sale Refreshments N/A $1000 Applicant will secure sponsor Tickets $5 per ticket 1000 $5000 From admission (use reverse side if necessary) TOTAL REVENUE: $ 6. Please list below any and all categories and amounts of expenses you expect to incur and the source from which they are to be paid. Category Amount each Quantity Total Source Examples: T-shirts $3 per shirt $300 Applicant will fund Refreshments N/A $1000 Applicant will secure sponsor Prizes $5 per prize $50 To be deducted from gross proceeds Tickets $.10 per ticket 1000 $100 Printing cost to be deducted from gross proceeds (use reverse side if necessary) TOTAL EXPENSES: $ 7. Approximate net proceeds to be contributed to Le Bonheur: 8. Will there be use of Le Bonheur's name and/or logo throughout the promotion? (circle) yes no

4 9. In what promotional materials (newspaper ad, radio ad, in-store signs, etc.) will you use Le Bonheur's name? How and where will the name appear in such materials? 10. Do you have any special needs for your fundraiser, and if so, will this require help from Le Bonheur? (See list of "What We Can Do To Help You Help Le Bonheur," last page.) Briefly describe: 11. Will any other businesses or organizations be contacted for donations (product or money), or assistance of any kind? If so, please list below: 12. If you are an owner or employee of a business, and would like to donate a percentage of sales or dollar amount of sales to Le Bonheur for a specific time period, provide the percentage or dollar amount of sales to be donated to Le Bonheur: Will this percentage be taken out of gross (total) sales or out of net sales (after all expenses are paid)? (circle) gross net 13. Any additional comments? EACH ITEM HEREIN IS SUBJECT TO REVIEW AND APPROVAL BY THE LE BONHEUR FOUNDATION AND CORPORATE COMMUNICATIONS DEPARTMENTS. Signature Date Thank you for your interest in helping the children of the Mid-South by organizing a fundraiser. Your time and efforts enable Le Bonheur Children's Medical Center to provide the highest quality of healthcare to over 130,000 sick and injured children each year. We appreciate your support!

5 What We Can Do To Help You Help Le Bonheur! We can provide your organization with: Informational brochures about Le Bonheur Fact sheets about Le Bonheur Le Bonheur canisters to collect money (must be returned) We have fundraising ideas--please contact us if you would like a copy We can help with publicity by: Writing and sending out press releases to print and tv media Placing an article in our Le Bonheur Express newsletter (available to approximately 1,400 employees) Placing flyers in visible areas on our campus and in your community