Third-Party Events

Please fill out all required fields indicated by an asterisk.*

ABOUT YOUR ORGANIZATION

Organization

Please provide the name of your business, group or non-profit organization.

Name of the person in charge of the event*

Please provide your first and last name.

Title

Please provide your title or position within the organization

Address*

Street Address City Province Postal Code

Telephone*

What number can we reach you on?

Mobile Phone

What number can we reach you on?

Email*

The email address you want to use for communication.

Enter Email Confirm Email

Fax

Enter the fax number you want to use for communication.

Please select the category that best describes your organization*

Select one category.

ABOUT YOUR PROPOSED EVENT

Event description*

Please describe your fundraising event, including location, cost per participant, etc.

Date of the proposed activity*

Location where event will be held*

ADVERTISING

Information on advertising*

Please describe the advertising you propose for this activity.

Do you want the Foundation to advertise this event?*

Yes
No

If yes, please indicate what you expect from the Foundation

Will pamphlets, posters and other collateral material be printed to promote this activity?*

Yes
No

If yes, please indicate the approximate dates of distribution.

Do you wish to use the logo and name of the HGH Foundation in your advertising?*

Yes - please provide a copy of your material before printing
No

EVENT FINANCIAL INFORMATION

Estimated revenues of this fundraising activity*

Estimated expenses for this fundraising activity*

Estimated gift to the HGH Foundation*

Estimated date of disbursement of donation to the Foundation*

Will other charities receive a gift following this fundraising activity?*

Yes
No

If yes, please indicate the names of these organizations

Do you require civil liability insurance?*

Yes (if so, please contact us)
No

HELP REQUIRED

What support or help do you need from the HGH Foundation?

Please check all applicable, and indicate quantities, if applicable, in the comment box.

Information documents on the Hospital and the Foundation
Copy of the Foundation logo
Lecturer (subject)
Volunteers
Other (please specify)

Comments on required support

Please note that the activities to raise funds for the Hawkesbury and District General Hospital and its programs are coordinated by the Foundation office.

The HGH Foundation accepts no financial or legal liability for the event.

All monies donated from your event will be allocated to improve the care and services offered to the community by HGH. If you would like the funds to go towards a specific campaign or service, please indicate which one in the comment box below.

Questions? - If you have any questions regarding this request, please contact the Foundation by calling 613-632-1111, ext. 21101, or by email: foundation@hgh.ca

Comments or suggestions

If you'd like to add anything else, please feel free to provide some additional information.

Consent*

I confirm that the information submitted is accurate and that I am authorized by my organization to submit it.

CAPTCHA

Name

This field is for validation purposes and should be left unchanged.

Social Media

Social Media

Events organized by third parties

How to proceed with the organization of a third-party fundraising event?

Third-Party Event Application Form

ABOUT YOUR ORGANIZATION

ABOUT YOUR PROPOSED EVENT

ADVERTISING

EVENT FINANCIAL INFORMATION

HELP REQUIRED