Third Party Event Registration Form

If you, your family, organization or business would like to plan an event or a program to help the Cape Breton Regional Hospital Foundation, we would love to know more.

Please submit the following application for approval. Application must be approved prior to advertising or hosting an event. Once submitted, a Foundation Office Staff member will contact you in 1-2 business days.

Your Name *

First Name Last Name

If your Organization or Business is putting on fundraising event, please let us know name of Business or Organization.

Relationship to Organization or Business(if applicable)

Email *

example@example.com

Address *

Street Address

Street Address Line 2

City Province

Postal Code

Phone Number *

Area Code Phone Number

Privacy statement

The information used on this form is collected is collected in accordance with the Personal Information Protection and Electronic Documents Act. Information collected is to be used by CBRFH Staff and Board only. We do not sell, trade, lease or share our donor lists with anyone.

About the Event

Name of Event *

Date of Event *

Estimated number of participants

Type of Event *

One-time Annual On-going

Location of Event *

Describe your Event *

Will other organizations benefit from event other than CB Regional Hospital Foundation? *

Yes No

If another Organization is benefiting from Event, please list them below:

What area of the Regional Hospital or Fund will this event support?

Source of Revenue

Ticket Sales Live/Silent Auction Cash Donation

What is your projected income of the Event?

What are your projected costs of the Event?

How and where will the Foundation’s name and logo be used, and where will the event be promoted?

As an organizer of this event, I agree to abide by the policies and procedures set forth in the Third Party Event Policy(please draw digital signature below): *

Clear