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Fundraising Agreement Form
Fancy raising a bit o’brass for us?
Please fill in the form below which helps us to learn more about your fundraising plans. Once received, a member of the team will be in touch to help guide you and get you going on your fundraising journey!
Fundraising Agreement Form
Contact Details
Name
(Required)
First
Last
Email
(Required)
Home telephone
Mobile
(Required)
Address
(Required)
Street Address
Address Line 2
City
County / State / Region
ZIP / Postal Code
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Event details
(Required)
Name and type of event, date(s), how money will be raised
Event venue
Venue or place event to take place
Names of other people / organisations involved
What made you decide to raise money for the charity eyup
Would you be happy for us to feature your event on our website?
(Required)
Yes
No
Would you be happy for us to use your event information on social media?
(Required)
Yes
No
Fundraising Materials
Please indicate if and how many you would like:
Sponsorship forms
Posters
Donations/ gift Aid forms
Inland Revenue will increase your donation by 25% if you and your supporters add GiftAid
EyUp T-shirt Large
EyUp T-shirt X-Large
Fundraiser logo
Collection Cans
(Required)
Collection Buckets
(Required)
Please specify how and where these will be used:
Must be collected and returned to the EyUp Fundraising office.
Will any other organisations benefit from your fundraising?
Yes
No
If yes, please state the % split to EyUp and the other charity(s) you have chosen to support:
I agree that all proceeds raised for the EyUp Charity from this event / fundraising initiative will be forwarded to the EyUp Fundraising Office on completion of fundraising. I understand that EyUp! cannot accept any responsibility for my fundraising efforts.
(Required)
I agree
Date
MM slash DD slash YYYY
I am happy to be contacted by EyUp! Charity in the future
(Required)
Yes
No
How we communicate with you As a valued supporter we really want to keep you posted about news and event across EyUp! Charity and to share how your support benefits our patients and their families. We will contact for you administrative purposes regarding this interaction. We will usually send you information by post and email. if you wish to change how we send you information or choose not to hear from us at all, there are a variety of ways you can do this. Ring us on 01924 316 403 or email EyUp.Charity@swyt.nhs.uk. For further information on how we use and store you details please visit our privacy policy. We will never sell your personal information.
Please tell us what type of activities you are interested in:
Black Tie / Balls / Dinners
Challenge Events
Cake Bakes
Art Events
Treks
Charity Lottery
Sporting Events
Volunteering
Own Fundraising
Email
This field is for validation purposes and should be left unchanged.
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