Sisters of Providence Health System
Third-Party Event Proposal & Agreement Form
Fund Development – Sisters of Providence Health System
271 Carew Street, PO Box 9012, Springfield, MA 01102-9012
Phone: (413) 748-9920 Fax: (413) 748-9977

Thank you for believing in our Mission and expressing interest in hosting an event to benefit the Sisters of Providence Health System (SPHS).In order to assist with your planning and ensure you are aware of relevant laws to conduct a fundraising event, please submit the Third-Party Event Proposal and Agreement Form . Every event requires a separate form completed for each event occurrence. Forms should be submitted at least six (6) weeks prior to the event. Please print, complete and either mail or fax the form to Fund Development c/o the Sisters of Providence Health System. If you have any questions or would like help completing the form please call our office, we will be happy to help you. You will be contacted upon receipt of your form.

To get started, follow these simple steps.

  1. Determine your event.
  2. Complete the proposal form.
  3. A member of the SPHS Fund Development Office will contact you with final approval of event and follow-up.

Mission: “We, Sisters of Providence Health System and Trinity Health, serve together in the spirit of the Gospel as a compassionate and transforming healing presence within our communities. We are sustained by an unwavering trust in God’s Providence”.

Event Information:

Name and/or Type of Proposed Event: ______

Proposed Date/Time of Event: ___/___/______am/pm to ______am/pm

Event Location: Street Address ______

City: ______State: ______Zip: ______

  1. Is the event: Open to the Public ( ) Invitation Only ( )

Who will you solicit? ( ) Friends ( ) Family ( ) Clients ( ) Other:______

How will you promote the event? ______

______

______

  1. Expected Event Revenue: $ ______Expected Total Expenses: $______
  1. How will expenses be paid?
    ( ) From proceeds ( ) By event organizer/Corporate Underwriting
  1. How will funds be raised? (check all that apply)

( ) Admissions (tickets, golfers etc.) ( ) Sponsorships ( ) Raffle ( ) Auction

( ) Online ( ) Other: ______

Is there a completed or pending permit application for the Raffle? Yes ( ) No ( )

  1. Event Frequency: One-time Event ( ) Annual Event ( ) Recurring/Ongoing ( )
  1. Event Beneficiary Information:
    Would you like the proceeds of your event to go to a specific program or department at the SPHS? Yes ( ) No ( )

If yes, which program or department? ______

(If No, the proceeds will go to an area with the greatest need)

  1. Would you like to invite members of SPHS to attend your event? Yes ( ) No ( )
  1. So that we can better help publicize your event please briefly explain why you have chosen SPHS, or an entity of SPHS, as the beneficiary for your event: ______
  2. Please briefly explain how you would like SPHS to assist you in planning and executing your event and we will make every effort to accommodate reasonable requests:

______

  1. Would you like your events to be publicized? (Ex: On Mercycares website, press release, etc.) Yes ( ) No ( )
  1. Name of Individual/Organization/Company Planning Event: ______

Name of Contact at Organization/Company (if applicable): ______

Street Address: ______

City: ______State: ______Zip: ______

Phone: (___)______Please check one ( ) Home ( ) Business ( ) Mobile ( ) Other

Date:___/___/___

Terms

  1. Before using SPHS’s name or logo or that of an SPHS entity (eg. Brightside, Mercy Medical Center, etc.) eitherto solicit prizes, sponsorship, underwriting or cash donations from another organization or to support the proposed event, promotion or sale, event organizer must request written permission from SPHS.
  2. Event organizer is held responsible for solicitingany prizes for the event.
  3. Event organizer ensures that the event venue will comply with all local and state laws and that any necessary permits and/or licenses (including raffle permits, liquor, food and beverage licenses, etc.) have been secured prior to the event date.
  4. Event organizer agrees to submit all promotional materials to the SPHS Fund Development Office at least 30 days prior to planned use, and will contact SPHS prior to any press interviews related to the event.
  5. Event organizer is fiscally responsible for the event.
  6. Requests for staff/volunteer assistance at the event should be made at the time of the proposal.
  7. Event organizer agrees to notify SPHS of the addition of any sponsors or beneficiaries that are being considered.
  8. Unless otherwise agreed to in writing by SPHS, a minimum of fifty (50) percent of the gross proceeds of the event must be donated to SPHS or its designated entitywithin sixty (60) days of the event’s conclusion. The best practice is to keep your expenses to thirty (30) percent or less of your total revenue.
  9. Event organizers indemnify and hold harmless SPHS from liabilities, losses and expenses arising from the event or promotion, and shall provide proof of insurance upon request of SPHS.

I, as the event organizer or as the duly authorized representative of the event organizer, have read and agree to abide by the terms set forth above by Sisters of Providence Health System. The details of the event are true to the best of my knowledge and I will immediately notify Sisters of Providence Health System if there are any changes.

EVENT ORGANIZER

Organization Name (if applicable): ______

Signature: ______Date:___/____/____

Printed Name: ______Title (if applicable): ______

PLEASE SUBMIT THIS FORM TO:

SISTERS OF PROVIDENCE HEALTH SYSTEM
ATTN: FUND DEVELOPMENT

271 CAREW STREET

PO BOX 9012

SPRINGFIELD, MA 01102-9012

PHONE: (413) 748-9920 FAX: (413) 748-9977

Upon Approval, a member of the SPHS Fund Development Office will contact you.

Internal Use Only

SPHS Representative Signature: ______

Date: ____/____/____

Printed Name: ______

Jan 2015

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