EmailMe Form - Cancer Society Canterbury-West Coast Division

Organisation Name if applicable

Title *

First Name *

Surname *

Email *

Daytime contact number *

Mobile number

Postal Address
Address 1 *

Address 2

Suburb *

Town/City *

Postcode *

Fundraising Activity/Event Details

Name of fundraising activity/event *

Date *

DD / MM / YYYY

Description of your fundraising activity/event *

Do you wish to use the Cancer Society name/logo on any promotional material? *

Yes

No

Would you like a Cancer Society representative to attend the fundraising activity/event? *

Yes

No

Terms and conditions *

I Agree

The Cancer Society of New Zealand, Canterbury-West Coast Division must approve all publicity and printed material bearing the Society's name and/or logo prior to its production and release.

The Cancer Society of New Zealand, Canterbury-West Coast Division will receive all net funds promised at the fundraising activity or event within 45 days of the conclusion of the activity or event.

Promotion *

Yes

No

I authorise the Cancer Society of New Zealand, Canterbury-West Coast Division to publicise the said event and/or activity in its public relations e.g. Let's Connect Newsletter, Canterbury-West Coast Division website & Facebook or other print media.