Volunteer Fundraising Event Form

Thank you for your interest in hosting an event to benefit Baystate Health Foundation (BHF), the charitable arm for Baystate Health System. Please complete this form and return it to our office via mail or email. Please submit your form at least six (6) weeks prior to the planned event.

A member of the Baystate Health Foundation team will review your event proposal and will contact you to discuss the event. You will receive authorization to proceed in writing.

Contact Information

*Primary Contact

*Title

Organization (if applicable)

*Mailing Address

*City

*State

*Zip Code

*Phone Number

*E-Mail

Event Information

*Proposed Event Name

*Nature of Event

*Date(s) and Time(s)

*Location/Venue/Name

*Street Address

*City

*State

Zip

*Is this event open to the public? No Yes

*Projected Attendance

Is there a specific hospital, outpatient center, or program your event will benefit?

Event Management

Have you conducted fundraisers or donated to BHF or its hospitals, outpatient center, or programs in the past? No Yes

How do you plan to promote this event?

*Is BHF the sole beneficiary? No Yes

If BHF is not the sole beneficiary, please list other beneficiaries

What are the proposed responsibilities for BHF?

Financial Information

*Do you plan to seek sponsorship from businesses or community groups? No Yes

If yes, please complete a prospect list and submit to BHF for approval. Please confer with BHF before contacting any prospective sponsors. Many local organizations already support BHF in some way and we try to keep overlap to a minimum.

Will a written financial summary be available to BHF? No Yes

*Estimated Total Proceeds

*Expenses (Including costs such as printing, food, entertainment, rentals, etc.

*Anticipated Net Proceeds (proceeds minus expenses)

*Estimated Amount/Percentage of Net Proceeds to be Given to BHF

This registration form does not authorize the sponsoring individual or organization or any representative of the sponsoring organization to act as an agent of Baystate Health Foundation, Inc., Baystate Health, Inc. or any of their affiliated entities or programs.

I agree that until written permission has been granted, contributions may not be solicited in the name of Baystate Health Foundation, Inc. or its affiliated entities or programs, and these names may not be used for any other purpose.

Once final approval has been granted, I agree to adhere to the policies and guidelines provided by BHF.

By submitting this form, I agree that I've read and understand all of the policies, guidelines, processes, and procedures outlined on the third-party event web page.