About you
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Name of organisation (if applicable)
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Have you previously raised funds for St Mary's House of Welcome? (yes / no)
*
Yes
No
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Fundraising Activity/ Event Information
Name of activity/event:
*
Date
*
-
Day
-
Month
Year
Date
Venue:
*
Please tell us about the fundraising activity or event you are organising, including how you plan to raise funds for St Mary's House of Welcome:
*
Will another charity benefit from this fundraising activity / event? (yes/no)
*
Yes
No
If yes, what is the charity name?
Percentage split?
Would you be interested in selling St Mary's House of Welcome merchandise at your event? (We can provide this on consignment).
*
Yes
No
Do you agree to the fundraising guidelines? (yes / no)
*
Yes
No
Signature:
*
Signed date:
*
-
Day
-
Month
Year
Date
Submit
Should be Empty: