Register an offline fundraiser

Title

First name *

Surname *

Company/organisation (if applicable)

Address *

Preferred contact number *

Secondary contact number

Email *

Your fundraising plan/event

Title of fundraiser/event

Tell us about your fundraiser/event *

Proposed dates (please mark the 'end' date as the date by which you will have collected all monies - funds must then be returned to the Institute within 14 days of the end date in order to comply with government regulations) *

Address/venue (if applicable)

Estimated number attending/donating *

How much do you hope to raise (in dollars)? *

Please direct the funds to:

Autism research

Wherever it is needed most

How do you intend to promote your fundraiser or event? *

Declaration

*

I accept the terms and conditions of the Institute’s Community Fundraising Guidelines.

*

I agree to conduct my fundraising activity in accordance with those terms and conditions and in a manner which upholds the values of CliniKids and the Telethon Kids Institute.

Full name *

Date *

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