Survey - Community Event Peer to Peer Registration Form - Southlake Regional Health Centre Foundation

Community Event Peer to Peer Registration Form

Thank you for starting a Peer to Peer Fundraiser in Support of Southlake!
Thank you very much for choosing to support Southlake and leading edge care for patients and families in our communities. Your answers to the following questions will be used to create a P2P Fundraising Page for your event! This page will be on the Southlake Foundation page (www.southlakefoundation.ca) and publicly available by searching.

Click here to view our Team Fundraising Page Design.

Question - Not Required - Are you fundraising as a:

Individual

Group or Company

Please provide your contact details:

Name:

Title	First Required	Last Required

Email: Required

Street 1: Required

Street 2:

City/Province/Postal:

City Required	State Required	Postal Required

Country: Required

Phone Number: Required

Employer:

Yes, I would like to receive email from Southlake Regional Health Centre Foundation

Yes, I would like to receive postal mail from Southlake Regional Health Centre Foundation

Question - Required - Can your phone number and/or email address be shared publicly?

Question - Not Required - Secondary Contact: If you have any additional organizers (for example a business partner or a primary business contact) please provide their name and contact information here.

Question - Required - Event Name:

Question - Required - Event Date:

Month

Day

Year

Question - Required - Start and End Time: Please also provide End Date if different than Event Date above.

Question - Required - Event Location:

Question - Required - Is this event open to the public?

Question - Required - Proceeds from this event will go to support:

Question - Not Required - Event Fundraising Goal:

Question - Not Required - Do you require promotional materials such as Southlake signage and/or brochures?

Question - Required - Will registration be done through our website?

Question - Required - Anticipated date registration will open:

Month

Day

Year

Question - Not Required - If registration will be hosted on our website, please provide more information on your registration needs. For example: are you charging a fee for registration, are there different registration types, is there a donation component for participants or the community, do you require any specific information from registrants?

Question - Required - Can participants register as part of a team?

Question - Required - Please describe your event. This description will be used to create your Peer to Peer Home Page. Consider mentioning: Cause you are supporting Who the event is for Event logistics Anything unique about your event

Question - Required - How will event funds be raised and/or costs be managed (i.e. registration fees, collecting donations, raffle, pledges, Sponsorships etc)? Please note: if running a raffle or draw guidelines under the AGCO requires a license.

(Maximum response 255 chars, approx. 5 rows of text)