Name of Individual/Group/Club/Company Planning the Fundraising Activity Or Event

Date:______

Name of individual/group/club/company planning the fundraising activity or event:

______

______

Type of business & products manufactured/sold (if a company):

______

______

Address:

______

______

Postcode: ______

Phone:______Fax: ______E Mail: ______

Contact Name: ______

Name of proposed fundraising activity or event:

______

Effective from:______Time (if an event):______

Location: ______

Description of fundraising activity or event:______

______

______

______

Estimated revenue ($): Estimated revenue to Cancer Society of New Zealand ($):

______

Do you intend to use the Cancer Society name and/or logo on any of the promotional material?(If yes, please describe below how)

______

______

______

______

Will you require a Cancer Society representative to attend the fundraising activity or event?(If yes, please describe the role the person will play)

______

______

______

______

______

______

Will you require any information from the Cancer Society?(If yes, please specify below – including quantities and a delivery address)

______

______

______

______

______

 I agree that the Cancer Society;

Must approve all publicity and printed material bearing the Society’sname and/or logo prior to its production and release.

Will receive all net funds promised at the fundraising activity or event within 30 days of the conclusion of the activity or event.

 I authorise the Cancer Society to publicise the said event and/or activity, for example; newsletter, website, facebook, or other print media.

NB: Whilst the Cancer Society will gratefully acknowledge all donations and proceeds it receives from community fundraising events,

(including provision of a tax receipt), it may not always be possible to provide a feature for every activity delivered in support of its cause.

Please e-mail/send/fax your request to:

MichelleGuest

Community Events Fundraising Coordinator

Cancer Society Wellington

04 389 0057 | 027 551 2059

Cancer Society Wellington

PO Box 7125

Wellington 6242

Thank you for choosing to support the work of the Cancer Society Wellington

to reduce the incidence and impact of cancer in our communities

Your proposal will be reviewed as soon as possible and you will be contacted within 7 days

Bank account details- for transacting donations

Bank ANZ Bank of New Zealand Ltd

BranchWellington Commercial Branch, 1 Victoria Street, Wellington

Account060577 0064826 02

A/C Name Cancer Society of NZ WgtnDivInc

SWIFT CODE ANZ 22

Sort Code 060577

Cancer Society of New Zealand is a registered charity under the Incorporated Societies Act, 1908 – CC10067

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