Fundraise for AHC - FORM - Angkor Hospital for Children

Host name and title:

Name of organisation or company:

Address:

Phone number:

E-mail:

Name of your fundraiser:

Location of your fundraiser:

Date of your fundraiser:

Time of your fundraiser:

Description of activities:

Have you read AHC's Third Party Fundraising Policy & Guidelines?

Yes No

Would you like to receive the AHC supporter logo as a digital file?

Yes No

Would you like to receive digital files of marketing materials and information to use in your collateral and promotional materials?

Yes No

Will 100% of gross donations be donated to AHC?

Yes* No**

If yes*, the estimated amount is:

If no**, the estimated amount is:

Will funds be coming directly to an AHC bank account or a third-party bank account?

AHC: AHC will receive the gross donation amount and the fundraiser is responsible for covering all expenses Third party: AHC will provide a report template of Profit and Loss for you to complete

Do you require an official Letter of Approval with the AHC stamp?

Yes* No

If yes*, which language?

Khmer English

If you have any, please share additional information/comments below:

By ticking this box, I accept and agree to abide by these terms and guidelines with respect to my fundraising activities and to AHC.