MND Blue : Request to Host an Event

Tell us a little more about you and your event to fundraise for MND NSW

I would like to fundraise with a:

Organisation (if applicable)

Brief Description of Event *

Organiser Phone Number *

Organiser Email Address *

Names of others assisting with the event

Please indicate where you would like funds raised directed to

Where it's most needed by MND NSW
Equipment
Support
Education and Information
Carers Support
Research

Do you already have, or intend to get, public liability insurance for your event? *

Yes
No

If YES, please provide details (eg insurer name, coverage limits etc)

NOTE: Authorised fundraisers for MND NSW are covered by its public liability insurance policy - subject to approval - for the
period of authorised fundraising. We can supply you with a copy of our public liability certificate of currency if required.

Tell us how you plan to promote your event

Please note, copies of any promotional materials must be submitted to MND NSW for approval prior to release.

(The names of sponsors promoted or used must also be submitted to MND NSW to allow us to ensure there is no
conflict with our policies.)

Event promotion details *

Will any other organisation benefit from your event? *

Yes
No

If you selected 'yes' above, please tell us the names of other organsisation/s who will benefit, and how (for example promotion, whether they will rec

Proportion (%) of fundraising event income to MND NSW *

Do you require raffle books? ($2 denomination, 25 tickets per book) *

Yes
No

If you require raffle ticket books, how many do you need?

Do you require merchandise to sell? *

Yes
No

Do you require collection containers? *

Yes
No

If you selected 'yes' above, how many do you need?

Any other event details?

Do you want to use the MND NSW logo?

Yes
No

Would you like MND NSW to post your event and contact details on our social media platforms?

Yes
No

Please advise your preferred contact for social media:

Fundraising Agreement and Guidelines

I have read and agree to the Fundraising Guidelines *

Yes

Together we can

MND NSW
Charity number CFN 11154 ABN: 12 387 503 221
All donations over $2 are tax deductible.

MND NSW Centre
Building 4, Gladesville Hospital Victoria Road Gladesville NSW 2111
fundraising@mndnsw.org.au mndnsw.org.au