Request to Fundraise Form

1. Organisation

Organisation Name *

Name of Contact Person *

First

Last

Title / Role of Contact Person *

Address *

Address Line 1

City

State / Province / Region

Postal Code

Email *

Phone *

Mobile

ABN

Enter 11 numbers only with no spaces

Website / URL

Facebook URL

Instagram URL

Twitter URL

2. Event

Event Name

Event Start Date

Event End Date

Event Location

Address

Address Line 1

City

State / Province / Region

Postal Code

Event description *

(please provide sufficient detail here)

Any other potential sponsors or other organisations involved?

Will this activity/event involve children? *

How do you intend on using the SJOS logo? *

Other logos being included – alongside SJOS? *

Do you require any other support from SJOS for the event? *

What support is required from SJOS for the event? *

Why choose SJOS as a/the beneficiary? *

3. Fundraising

Support for SJOS will be through:

1. Proceeds

(of tickets, sales, other activities etc, Nett of any costs)

Proceeds Esimate $

2. Donations

($2+, requiring Tax Receipt)

Donations Esimate $

3. Donations via Collection Tin

Donations via Collection Tin Esimate $

4. Gifts in Kind

(Goods/Services donated direct to SJOS)

Gifts in Kind Esimate Value $

Mechanism for fundraising i.e. how will funds/donations be raised?

How will funds be collected and managed, and ultimately transferred to SJOS?

How will the event be publicised/promoted?

Estimated number of attendees at/over this activity?

Any significant dependencies/risks to achieving your goals?

List all beneficiaries of the proceeds of this activity (and % split)

Outline any 3rd party donations of goods or services you will seek in support of this event?

Intending to collect any tax deductable donations ($2+)? *

Please describe *

Estimated Gross Total Funds Raised

Estimated costs (if any) to be deducted from funds raised

Amount to be directed to either: *

Area of greatest need
Specific SJOS program or service (name)

(please indicate)

Please specify *

Date / Time

4. Agreement

I (individual responsible for fundraising activity/event) accept SJOS’s fundraising terms and conditions (including current Victorian fundraising legislation) on behalf of my organisation as provided to me.
In conducting my fundraising activity/event, I agree to comply with these terms and conditions in a manner that upholds SJOS’s values.
I agree the funds will be provided to SJOS within four weeks of the event/fundraiser being held.

Name *