Community Fundraising Event Form

Name of the event

Date

Time

Location

Briefly describe the event

Do you need a letter of support from Wake Forest Baptist?

Yes

No

Do you plan on using the Wake Forest Baptist Health logo?

Yes

No

Do you have a Facebook page for the event?

Yes

No

How will you promote this event?

How will the funds be raised?

Ticket Sales

Sponsorships

Auction/Raffle

Other

Who will you solicit?

Friends

Family

Clients

Local Businesses

If businesses will be solicited, please list their names

Is Wake Forest Baptist the sole beneficiary?

Yes

No

If no, please list other beneficiaries

Where would you like your funds directed?

Brenner Children’s Hospital Fund

Dean’s Fund for Education

Diabetes Research Fund

Discovery Fund the Comprehensive Cancer Center

Excellence in Heart and Vascular Fund

Gerontology Support and Research Fund

Regenerative Medicine Fund

How will expenses be paid?

From proceeds

By event organizer

Anticipated total funds raised

Anticipated total expenses

Anticipated donation

I agree that Wake Forest Baptist Health will receive proceeds from the event within 30 days of the event.

I agree that all printed materials and publicity for the event must be approved by Wake Forest Baptist Health prior to being released, printed, etc.

I have read the guidelines for community fundraisers for Wake Forest Baptist Health and agree to follow them as stated.

myWakeHealth

myWakeHealth

Community Fundraising Event Form