Fundraising Registration Form | Queensland Eye Institute

Personal Details
Contact Name*

Person to contact who is coordinating the event or activity
Phone*
Mobile Phone (if different)
Group / Club or Organisation Name
Address*
Suburb/Town/City*
State
Postcode*
Email*
Event Details
Name of proposed event or activity*
Event Location
Address of venue
Date event starts*
DD slash MM slash YYYY
Time event starts (if known)
Date event finishes*
DD slash MM slash YYYY
Brief description of event or activity
How will fund be raised?
Is the event supporting any other charity?
- Yes
- No
What support do you require from QEI?
Please be as detailed as possible.
Event promotion approval
- Yes
- No
Please specify if you agree to allow QEI to promote or publish details of your event.
Agreement*
- I agree
I agree to act in a professional manner in conducting the fundraising activity and uphold the integrity and values of the Queensland Eye Institute. I also accept my obligation to remit the funds raised to the Queensland Eye Institute within 14 days of the event conclusion. You will be contacted by a fundraising team member with the full terms and conditions for fundraising on behalf of QEI. Prior to publicising or conducting any event you must obtain Queensland Eye Institute's approval.