Community Partnerships Form

Thank you for expressing interest in organizing a fundraising event for New Hanover Regional Medical Center Foundation. Please submit this application to the best of your ability at least four weeks prior of the intended event date or fundraiser. NHRMC Foundation reserves the right to withdraw support of the third-party event should the organizer deviate from the approved submission.

Contact Information

First Name

Middle Name

Last Name

Address

Phone Number

Company/Organization

Contact's Relationship to Company/Organization

Event Information

Event Name

Event Date

Event Time

Event Location

Description of Event

Expected Attendance

Event is:

What are the estimated proceeds to benefit NHRMC Foundation?

How will donations or proceeds be collected?

Are there other charities involved? If so, please describe their involvement.

How will NHRMC Foundation receive the proceeds from the event? (Check all that apply.)

Expected date for the transfer of funds

Fund Designation

Event Support

If available, would you like literature to distribute about NHRMC Foundation and/or services at NHRMC?

If yes, how many copies?

If possible, would you like to have a NHRMC Foundation representative at your event?

If yes, what role would the representative play?

Please provide a time frame of when a representative would be needed.

Event Promotion

Describe your plans to publicize or market your event.

Do you wish to use the name and/or NHRMC Foundation logo in your promotional materials?

Additional Information

How did you hear about NHRMC Foundation?

Please describe what motivated you and your group to organize and conduct this event.

How will you fund your event?

Guidelines for Fundraising Acknowledgement

I have read and agree to comply with the Guidelines for Fundraising established by New Hanover Regional Medical Center Foundation.

Yes