Fundraising Registration Form

Fundraising Application Form Header — Fundraising Registration Form

Please complete the form below at least three weeks in advance of your fundraising activity.

You may also apply by filling out a paper version of our application form and returning it to Fundraising, St Luke's, Little Common Lane, Sheffield, S11 9NE or sending a scanned copy to [email protected]

Required fields are marked with *

Your fundraising

How are you fundraising?

Is it in memory of someone?

Yes
No

If yes, please tell us their full name and relationship to you.

Event date

Start time

Finish time

Venue address

Approximate number of attendees

Fundraising target

Your details

Title*

First name*

Surname*

Address Line 1*

Address Line 2

Town/ City*

Postcode*

Email*

Telephone*

Date of birth*

We ask for DOB because special rules apply to how we communicate with you if you are under 18.

Keeping in touch

St Luke’s would like to contact you about our work, future fundraising events and how your donations help. Please let us know if you would like to hear from us via:

Select choices

Email
SMS

We may also contact you by post and telephone about our work and how you can support us.
You can opt out of communications by contacting us at any time. Please contact us on
0114 235 7551 or email [email protected]

We will never sell or swap your details with other organisations for them to use for their own purposes. If you want to know more about how we look after your data, please see the privacy notice which is available on our website - www.stlukeshospice.org.uk/footer/policies

Fundraising agreement

I will:

1. Use my best endeavours to raise money for St Luke’s and not do anything to bring St Luke’s into disrepute.
2. Obtain and pay all monies raised to St Luke's within three months of my fundraising activity.
3. Seek approval from St Luke’s if planning to produce any materials bearing the St Luke’s name and logo or that discusses the work and organisation, ensuring that I receive explicit permission from St Luke's for all materials before printing and distribution.
4. Ensure that all materials include the Registered Charity No: 254402.
5. Not carry out house-to-house collections.
6. Not collect in any public place without contacting the fundraising team first. You can contact us on 0114 235 7553.
7. Not collect on private property without first obtaining permission from the owner.
8. Refer to Gambling Commission regulations if holding a raffle.
9. Return any unused fundraising materials no longer required.
10. Not resell or offer for auction any St Luke’s merchandise without permission.
11. Pass on 100% of all proceeds from any permitted activity soley to St Luke’s (unless otherwise agreed).

I understand that St Luke’s may terminate my rights to raise funds at any time.*

Agree

Signed by:*

Full name/name of parent or guardian

Please note: If you are under 16 years of age, a parent or guardian will need to sign this form on your behalf.