Brenner Children's Community Fundraiser Event Form

Name of Organization or company planning event Contact Person Title Mailing Address Organization/Company Website Home Phone Work Phone Cell Phone Email Briefly describe your organization or company Name of the event Date Time Location Briefly describe the event Why did you choose Brenner Children's to be the beneficiary of your event? How will you promote this event? How will the funds be raised? Ticket Sales Sponsorships Auction/raffle Other If other, please explain Who will you solicit? Friends Family Clients Local Businesses If businesses will be solicited, please list their names If no, please list other beneficiaries Where would you like your funds directed? Brenner Children's Patient Assistance Fund Children's Cancer Fund Children's Cancer Support Program Neonatal Intensive Care Unit Fund Child Life Fund Brenner F.I.T. Area of greatest need Other If other, please list How will expenses be paid? From proceeds By event organizer Anticipated total funds raised Anticipated total expenses Anticipated donation