Daytime Phone:

Evening/Weekend Phone:

Cellular Phone: Fax:

Email:

Event Information
Event Description:

Proposed Date:

Location:

Event Income & Expenses- please list sources and anticipated amounts of income and expenses for the event:
Income:

Expenses:

Will Hospice Chautauqua County be the sole beneficiary of the event? If not, please describe how proceeds will be distributed:

Does the sponsoring organization have its own checking account? If not, how will income and expenses be handled:


How can Hospice volunteers assist with the event?


What goods and services would you like to have donated?


Will you be seeking sponsors or will the event require the collaboration of other businesses or organizations?


How will the event be publicized and how can Hospice help?