Fundraising Registration - Breakthrough Mental Health Research Foundation

Contact Details

First Name*

Last Name*

Date of Birth

Email*

Phone*

Mobile

Address*

Suburb*

State*

Are you organising a fundraiser on behalf of an organization?*

Please indicate if you are you organising a fundraiser on behalf of your workplace, community group, sporting club or other organisation

Name of Organisation*

ABN

Area fundraising for

Estimated fundraising amount

Estimated expenses amount

Why did you choose to fundraise for Breakthrough Mental Health Research Foundation?

Will another organisation benefit from the fundraising? Please state other beneficiaries (if any)

Name of Event/Activity

Description

Proposed Date

Proposed Time

: HH

MM

Location

How will funds be raised?

Please explain how will funds be raised?

Terms and Conditions*

I understand that the Breakthrough Mental Health Research Foundation reserves the right to withdraw approval of this activity at any time should the event or the activity organiser/s fail to comply with the Breakthrough Mental Health Research Foundation Guidelines. I understand that the Breakthrough Mental Health Research Foundation and its staff and volunteers cannot be held responsible for any loss or damage that occurs as a direct or indirect result of this activity. I am in a suitable physical and mental condition to organise and run this activity and have considered any and all risk that may be associated with this event.

Newsletter Subscription

Breakthrough Mental Health Research Foundation respects your privacy. We would like to keep you informed of our activities, however if you do NOT wish to receive further information please tick this box.