Prisma Health Office of Philanthropy :: Community Led Fundraising Event & Activity form

Community-Led Fundraising Event & Activity Form

Prisma Health Office of Philanthropy
The Prisma Health Office of Philanthropy is the fundraising arm of Prisma Health–Upstate. Our purpose is to serve the private giving needs of the health system by raising and managing private gifts, then directing those funds and assets according to each donor’s intention. We connect donors with their passion for transforming health care in the Upstate, all in support of Prisma Health’s purpose:

Inspire health. Serve with compassion. Be the difference.

Prisma Health-Upstate tax identification number is: 81-1723202
Thank you for your interest in raising funds and awareness for Prisma Health-Upstate. Please complete and submit this form and we will contact you regarding your proposal within a few days.

Prisma Health Office of Philanthropy
Contact Name

First NameLast Name
Name of Organization
Email
example@example.com
Phone Number
Please enter a valid phone number.
Mailing address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of your proposed fundraiser:
Briefly describe your proposed fundraising event or activity:
Is this a public event/activity?

YesNo
Date of proposed event/activity:
Time of proposed event/activity:
Proposed location/address of the event/activity:
Price / Admission for the proposed event/activity:
Expected number of attendees/participants:
Which Prisma Health-Upstate service line are you raising funds? (i.e. - Children's Hospital, Cancer Institute, Women's Services, etc)
Will this fundraiser benefit any charity other than Prisma Health-Upstate?
If yes, please list the name(s) of the other organization(s)?
How will funds be raised (ticket sales, product sales, etc.)?
Expected donation to Prisma Health-Upstate:
How do you plan to promote this event/activity?
Include any additional details here. You can also upload any documents or files:
Document or File Upload

Cancelof

Prisma Health-Upstate Community-Led Fundraising Release, Hold Harmless and Indemnification Agreement

FORM 1 OF 2

Please review carefully, sign, and submit.

For valuable consideration, including the consent of Prisma Health-Upstate to use its name and/or logo in promotional activities or materials, the undersigned, on behalf of the organization identified below, being authorized to do so, does hereby agree to release, hold harmless and indemnify Prisma Health, its directors, officers, employees and representatives from any and all liabilities and claims of liability, of any nature whatsoever, arising out of, or in connection with, the event or activity conducted by the organization identified below in which the name and/or logo of Prisma Health is used, including promotion of such event.

The undersigned agrees and expressly represents that Prisma Health-Upstate is not a joint venture with the undersigned organizer in the conduct of the event, that Prisma Health-Upstate is not involved in the management, conduct, or sponsorship of the event, and that Prisma Health-Upstate is merely a charitable beneficiary of a portion of the proceeds derived from the event.
Name of Organization or Organizer
Organization Name
Signature of Authorized Person

Clear
Printed Name

First NameLast Name
Title
Date

MonthDayYear
Date

Prisma Health-Upstate Community-Led Fundraising Agreement

FORM 2 of 2

By signing my name below, I state that I have read and agree to the Prisma Health Office of Philanthropy Community-Led Fundraising Proposal Guidelines (www.PrismaHealthUpstateGiving.org/CommunityLedFundraising) and have signed the Release, Hold Harmless, and Indemnification Agreement on the previous page
Name of Organization or Organizer
Organization Name
Signature of Authorized Person

Clear
Printed Name

First NameLast Name
Title
Date

MonthDayYear
Date
Prisma Health Office of Philanthropy
300 E. McBee Avenue
Suite 201
Greenville, SC 29601
Phone 864 797-7746
Fax 864 797-7705
Email Giving@PrismaHealth.org
Should be Empty:

Community-Led Fundraising Event & Activity Form