Ronald McDonald House Charities^® Southwestern Ontario How To Help

Group or Organization: *

Contact Person: *

Mailing Address: *

Street Address:

Address Line 2:

City:

Postal Code:

Phone Number: *

Email Address: *

Name of your Event: *

Date(s) and Time(s) of your Event: *

Venue Address (if applicable):

Street Address:

Address Line 2:

City:

Postal Code:

Briefly describe the Event: *

Your Event Website (URL):

Your Event Social Media (URL):

How will funds be raised?: * Ticket Sales Sponsorship Auction Other

If other, please describe below:

How much do you expect to raise after expenses?: *

What do you expect your event expenses to be?: *

Estimated date funds will be received by RMHC: *

Does your event require a license? * Please note that certain gaming events, such as raffles or bingo, require registration and licensing with the province. Yes No

Are there other beneficiaries of the event? * Yes No

If yes, please specify the other organizations and what percentage RMHC will receive:

Asset agreement: * I agree to use the RMHC logos, photos, and assets provided in the RMHC Third-Party Fundraising Toolkit Terms agreement.

Terms agreement: * The undersigned has read, understands, and agrees to the terms of the Fundraising Guidelines of Ronald McDonald House Charities® Southwestern Ontario, attached hereto, and further agrees to release, defend, and hold harmless Ronald McDonald House Charities Southwestern Ontario, and any of its affiliated or related companies, and each of their successors, underwriters, insurers, agents and assigns of and from any and all claims, demands, damages, actions, causes of action, or suits of any kind or nature sustained or alleged to have been sustained by any person or entity as a result of the project or event described above.

Todays Date: *

First Name: *

Last Name: *

Organization: