EmailMe Form - Community Fundraiser Registration Form

First name *

Last name *

Organisation or group (if applicable)

Address Details

Address 1 *

Address 2

Suburb *

Town/City *

Postcode *

Go to NZ Postcode Address & Post code Finder

Email *

Daytime contact number *

Mobile Phone

Date of Birth

MM / DD / YYYY

If under 16 years please provide the contact details of your parent(s) or caregiver(s) so we can obtain consent.

Fundraising Activity / Event Details

Name of fundraising activity / Event

Description of your fundraising activity/event *

Date effective from *

DD / MM / YYYY

Location of event (if applicable)

Estimated expenses

Fundraising target

Will you be seeking sponsorship from a third party?

Yes

No

If yes, who will you target

Name of potential sponsor(s)

Will another organisation benefit from the activity?

Yes

No

If yes, include details of who will benefit and the percentage they will receive

Do you require a Cancer Society representative to attend the fundraising activity / event? *

No

Yes

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

No

Yes

What resources do you require (e.g. brochures, pamplets, donation buckets, balloons; or merchandise and decorative materials.

Terms and conditions *

I Agree

The Cancer Society Auckland Northland must approve all publicity and printed material bearing the Society's name and / or logo prior to its production and release

The Cancer Society Auckland Northland will receive all net funds promised at the fundraising activity or event within 45 days of the conclusion of the activity or event

Promotion *

No

Yes

I authorise the Cancer Society to publicise the said event and / or activity in it's public relations e.g. Facebook, website, Newsletter, Print media

Please submit this form and someone from our fundraising team will be in contact with you as soon as possible