Sainte-Justine Hospital Foundation - For the Love of Children :: Organize a Benefit

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5757, avenue Decelles, Bureau 335, Montréal (Québec) H3S 2C3
(514) 345-4710 or
Toll-free:
1-888-235-3667
fondation@sainte-justine.org

Visit the CHU Sainte-Justine Web site at
www.chu-sainte-justine.org

Proposal for Holding a Benefit Activity

Thank you for helping the children, adolescents and mothers at Hôpital Sainte-Justine! Please fill out this agreement and send it to us online. You may also print and mail it to the following address:

Sainte-Justine Hospital Foundation / Benefit Activities
5757, avenue Decelles, bureau 335
Montréal (Québec) H3S 2C3

A receipt will be sent to you when your proposal is received.

Note: Your proposal must be accepted by the Sainte-Justine Hospital Foundation before starting to promote your activity.

1. The Organizers

Name of organization:
Name of person in charge:
Title:
Address:
City:
Postal Code:
Telephone(Home):
Telephone(Work):
Telephone(Cell):
Fax:
Email address:
Web site:
Committee members:

2. The Activity

Name of activity:
Date planned:
Time:
Place:
Address:

3. The Budget

All organizing expenses must be paid from the money raised by the activity or by the organizers. Please enter all the costs, even those covered by sponsors. Remember: By lowering your costs, you increase your proceeds!

Gross revenue forecast:	$
Number of participants:	$
Revenue forecast per participant:	$

Expenditures

Rental fees:	$
Food/beverages:	$
Printing of material:	$
Security:	$
Advertising/promotion:	$
Permits and/or insurance:	$
Door prizes:	$
Other (specify):	$
Total expenditures:	$

Net revenue forecast:

Additional Information

Do you need a permit to hold your activity?
(Required for such activities as a bingo, a raffle or draw, or a casino)

YES:

NO:

Have you planned for insurance for your activity?

YES:

NO:

NOT APPLICABLE:

Please indicate the quantity of promotional items you will need:

Posters:			Dimensions:
Banners:			Dimensions:
Donation boxes:
Pins:

Presence of the Sainte-Justine Hospital Foundation mascot*

YES :

NO :

*A minimum fee of $150 will be charged to you for the services of the mascot Cachou and cleaning the costume.

Please Note

On request, the Foundation will issue an income tax receipt to the participants and/or organizers of the fundraising event for the net value of their donation.
The Foundation is not responsible for any commitments made by the organizing committee of your fundraising activity.
If you must sell tickets for your activity, make sure to plan for the help of one person for each increment of 10 tickets to be sold. The Sainte-Justine Hospital Foundation is not responsible for selling your tickets.
The Foundation reserves the right to cancel the project if, for serious reasons, it does not agree with the use of its name and logo.
The organizing committee releases the Sainte-Justine Hospital Foundation from any responsibility of any nature whatsoever related to the benefit activity, and assumes any litigation resulting from said activity.
On behalf of your organization, you must agree to turn any profits over to the Sainte-Justine Hospital Foundation within 45 days of holding the activity.
On behalf of your organization, you must agree to obtain the approval of the Foundation for all advertising and promotional material related to the activity, as well as for the use of the Foundation logo.
On behalf of your organization you must agree to respect this agreement in its entirety.


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