SHCF Fundraiser Agreement Form

By answering the following questions, you will help us learn more about your event.

A member of the SHCF staff will contact you to discuss your fundraiser.

* indicates required field
* Name of Organization or Individual:
Contact Person (if different from above):


* Street Address
* City
* State
* Zip Code
* Email
* Phone
Name and Description of Event:
Event Date:
Event Time:
Event Location:
* Participation in this event is:
Has this event taken place before?
If you chose "YES", when did it take place?
Are there other beneficiaries besides SHCF?
If you chose "YES", please list them
Estimated Gross Revenue:
Estimated Total Cost:
Estimated amount to be given to the SHCF:
SHCF works closely with many local corporations and businesses. Please let us know in advance the names of any corporations or businesses you plan to solicit for your event. Please list below.
SHCF will need to review all materials that include the names/logos of Somerset Medical Center and Somerset Medical Center Foundation. (Please read Logo Guidelines.) Please outline your publicity/promotion plans.


Thank You and Good Luck!