COMMUNITYEVENTAPPLICATION/AGREEMENTFORM

HostinganeventorfundraiserforJDRFisagreatwaytogetyou,yourfamily,friendsandcolleaguesinvolvedinacceleratingdiabetesresearch.Weareverygratefulforyoursupportandwanttohelpyoumakeyoureventmemorableandsuccessful.

ORGANIZER(S) TYPEOFEVENTNAMEOFORGANIZINGGROUP □BENEFITDINNERORLUNCH □CONCERT

□SPORTINGEVENT □GOLFTOURNAMENT

CATEGORY(SCHOOL,COMPANY,INDIVIDUAL,COMMUNITYGROUP,OTHER) □FASHIONSHOW □JDRFWALKSUPPORT

□OTHER(SPECIFYBELOW) □JDRFRIDESUPPORT

PRIMARYCONTACT ESTIMATEDNUMBEROFPARTICIPANTS:________________EMAIL FUNDRAISINGADDRESS WHATTYPEOFFUNDRAISINGACTIVITIESWILLYOUDO?

□SALEOFTICKETSORGOODS □AUCTION

CITY/PROVINCE POSTALCODE □RAFFLE □PERFORMANCE

□MATCHINGGIFTSBYEMPLOYER □OTHER__________________TELEPHONE(HOME) TELEPHONE(WORK) ORSPONSOR CELL WHATAREYOURANTICIPATEDREVENUESTREAMS VENUERENTAL

□IgivepermissionforJDRFtocontactme,includingbyemail,aboutitsactivitiesandhowIcansupportitsmissiontoaccelerateT1Dresearch.Youcanwithdrawyourconsentatanytime.

FOODANDDRINK PERMIT,LICENSE,OROTHERAUTHORIZATION INSURANCE

ADVERTISINGANDPROMOTIONALMATERIALS EVENT PRINTING(INVITATIONS,POSTERS,ETC.) NAMEOFEVENT AUDIOVISUALS SECURITY

DATE(DAY-MONTH-YEAR) TIME DOORPRIZES DECORATION LOCATION MISCELLANEOUSFEES TOTALANTICIPATEDEXPENSES ADDRESS CITY/PROVINCE POSTALCODE ANTICIPATEDDONATIONTOJDRF: _______________

RECURRINGEVENT DOESTHISEVENTOCCURREGULARLYORAREYOUPLANNINGONHOLDINGTHIS EVENTAGAIN? □YES□NO WHEN?_____________________________ EVENTRENEWAL HAVEYOUHELDTHISEVENTPREVIOUSLY? □YES□NO WHEN?_____________________________

RECEIPTS

NOTES

□Taxreceiptsrequired(ifchecked,werequireacompletedThirdPartyFinancialReportbeforereceiptscanbeissued.ThisisrequiredasperCRArequirements.)Donationsover$20willreceiveataxreceipt.

• JDRFreservestherighttorefuseanevent.Forexample,fundsraisedmustrespectthebrandingofJDRFandthepoliciesandguidelinesestablishedbytheCanadaRevenueAgencyandJDRF.

□Taxreceiptsnotrequired OTHERBENEFICIARIESOFTHEFUNDRAISER • FundsreceivedbyJDRF(on-lineorotherwise)willbeassignedtoJDRF.

TheycannotbereclaimedbytheeventorganizertocoverexpensesWillfundsbeallocatedtoanyotherorganizations? □YES□NO CONDITIONSPleaselistthenameoftheorganization(s)receivingproceedsfromyour □IagreethatallfundraisingeventsforJDRFmustbeapproved,evenbeforefundraiser.Ifapplicable,specifythepercentagethatwillbedonatedtoeach. theeventisorganized □Iagreetoforwardallfundsraisedwithinnomorethan45daysafterthe eventisheld □Iagreethatallcommunications(invitations,tickets,solicitationfor sponsorships,advertisements,posters,etc.)featuringthenameandlogoof JDRFmustbesubmittedforapprovalpriortodistributionPROMOTION □IamawareoftheCanadaRevenueAgency’spoliciesandguidelineswithPleasedescribewhatstepswillbetakentoletpeopleknowaboutyourevent regardstodonations,andIagreetoadheretothemandraisefunds. □IhavereviewedJDRF’sCommunityEventFrequentlyAskedQuestions □IagreetoholdJDRF,itsagentsandemployeesharmlessforanydamages, financialobligationsorliabilitiesthatmaybeincurredbythisevent SIGNATURE DATE

THANKYOUFORSUPPORTINGJDRF ANDTHETYPE1DIABETESCOMMUNITY SUBMITTINGYOURFORM Thisformcanbesentbymail,fax,emailorinpersonto:EVENTSUPPORT JDRFCanadaJDRFcanprovidesupportforyourevent.Pleasecompletethecheckboxesbelow:

235YorklandBlvd.Suite600,

□JDRFBanner/Sign/Logo TorontoON,M2J4Y8□JDRFInformationBrochures Toll-Free:1-877-287-3533□Speaker/YouthAmbassador Telephone:647.789.2000□Volunteers Fax:416.491.2111□ChequePresentation Email:general@jdrf.ca□RecognitionOpportunities □UseoftheJDRFonlinefundraisingtools FORJDRFUSEONLYCOMMENTS Pleaseattachanyadditionalrelevantinformationtothisform APPROVEDBY

SIGNATURE

DATE

AGREEMENTNUMBER