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Personal Details

Title*:
First Name*:
Last Name*:
Name of Organisation (if applicable):
Role in Organisation:
ABN:
Street Address*:
Suburb*:
State*:
Postcode*:
Email*:
Daytime Phone*:
Mobile:
Fax:
Preferred Method of Contact*:
How did you hear about us?*:
Other:
What is the main reason you have chosen to support NBCF?*:

Further details (optional):

Referee
Full name of Referee* (cannot be a relative or guardian):
Referee Email*:
Referee Contact Number*:
Activity Details
Proposed title of the activity*:
Proposed Activity Start Date* (DD/MM/YYYY):
Proposed Activity End Date* (DD/MM/YYYY):
Proposed Time of Activity:
Estimated No. of Guests:
Proposed Venue*:
Venue Address:

Please briefly describe your event/activities*:

Will you be collecting donations for the NBCF?:	Yes No
Will you be holding an auction?:	YesNo
Are you selling tickets to your event?:	YesNo
Ticket Price:
Amount/percentage donated to the NBCF:
Will you be holding a raffle?:	YesNo
Raffle Ticket Price:
Value of raffle prizes:
Date Raffle Drawn (DD/MM/YYYY):
How many receipt books do you require?:
How many donation boxes do you require?:
Will there be associated sponsors?:	YesNo
Name of Sponsor(s):
Will you be supporting another charity?:	YesNo
Name of the other charity:
Please support me by:	Sending a press release template Listing on NBCF community events website Sourcing a speaker for my event
Budget
Estimated Income*:
Ticket Sales:
Raffle Tickets:
Auction:
Other:
Other:
Estimated Expenditure*:
Venue:
Food:
Prizes:
Printing:
Other:
Estimated NET income to the NBCF*:
Insurance
Disclaimer: NBCF is unable to provide public liability insurance cover to CFR events and/or coordinators. It is the responsibility of the event coordinator to arrange this. According to the Best Practice Guidelines of the Office of Liquor, Gaming and Racing NSW event costs should also not exceed 40% of total income.
Do you have Public Liability insurance?:	YesNo

Agreement
Yes	By clicking this box I acknowledge that I have read and agreed to the terms and conditions outlined under Fundraiser Agreement.*

Personal Details

Referee

Activity Details

Budget

Insurance

Agreement