MARYMOUNT FUNDRAISING EVENT FORM
On behalf of Marymount University Hospital and Hospice, a very sincere thank you for your interest in raising funds to
help support all who need Marymount’s services. Completing this form does not imply authorisation from Marymount
to undertake this event on our behalf, when we have processed your form we will be in touch to authorise your event.
Please type the form below or print clearly and tick where appropriate.
TITLE:
FIRST NAME:
SURNAME:
If yes please detail:
Have you fundraised for Marymount before : Yes 
No 
COMPANY/SCHOOL/COLLEGE/COMMUNITY GROUP: (if applicable)
POSTAL ADDRESS:
TEL/MOBILE:
EMAIL:
From time to time we would like to contact you about our news and how your wonderful support has helped us. Please
tick the below how you would like to be contacted (can be multiple options):
 Email
 Phone
 Post
 Do not contact
EVENT NAME:
DATE:
TIME:
VENUE:
Is your event in memory of someone? If so, kindly give name and details:
FUNDRAISING GOAL: €
CAN WE HELP? Yes, please detail quantity needed in the boxes below:
TSHIRTS: S: _
SPONSOR CARDS:
COLLECTION BUCKETS:
M:
L:
POSTERS: A4
XL:
A3
BALLOONS:
STICKERS:
(buckets must be collected from the office)
(*Please note there is a substantial cost to us to produce collection buckets & tshirts, please be mindful when ordering quantities.
Please return all buckets and any unused tshirts after your event to Marymount, thank you)
PRIZES: If you are collecting prizes for your event, please ensure you email Ger/Marie on who have donated prizes. This is
so that we know who has been asked on our behalf. We would really appreciate this.
ANY OTHER CHARITIES/BENEFICIARIES: If yes please include clearly on any merchandise
PLEASE SHARE YOUR STORY (OPTIONAL): If you are fundraising for us because you have a particular reason why you have decided to
raise funds for Marymount, please tell us. Your story can provide motivation and inspiration for others to do the same. If you are
happy for your story to be published online and in our literature please tick this box:
(we will never publish your name
without specifically requesting your permission)
I agree to comply with any legal requirements & our conditions for fundraising as stated overleaf:
Fundraiser Signature: ___________________________
Date: ______________________
(A printed digital signature is acceptable if sending by email)
FOR OFFICE USE ONLY
Reference Number:
Authorised By:
Permissions to fundraise apply only to the events/activities described on this form. Signed & approved on behalf of Marymount
Staff Signature: ________________________________
Date: ______________________
THANK YOU FOR CHOOSING TO SUPPORT MARYMOUNT
On behalf of Marymount, a sincere thank you for your interest in raising funds to help support all who need
Marymount’s services.
To help you organise your event, we have put together a list of points that should be adhered to, to protect all
participating parties. If you have any queries, please don’t hesitate to contact the Fundraising Team on
[email protected] or tel: 021 4501201.

Marymount is happy to offer advice and guidance for coordinating your activity, however, the overall running of
the event, including expenses, promotion, record keeping and management is ultimately your responsibility.

The organiser of any fundraising event or activity must abide by all applicable legislation and apply for any
permits/permission that may be required. This is inclusive of all raffles, bingo, vending tickets, other games of
chance or any public appeal. These are available through an application process at your local Garda station.
Copies of any permits should be sent to the Marymount Fundraising Office.

Organisers are advised to ensure they have the relevant insurance and indemnity considered necessary in
association with any event involving the general community or individual members of the public. Our insurance
policy does not cover events conducted by external fundraisers. A copy of your insurance policy should be sent to
the Marymount office

Organisers wishing to use our name and logo must gain approval first. Our logo can be supplied by e-mail to you
upon request. A proof/link of the suggested use of the logo, must be submitted to the office for approval prior to
printing/publishing.

All publicity in reference to the fundraising event/activity should clearly state that the event/activity is being
organised by (name of organiser/company). All promotional material must be worded in such a way as to make it
clear that Marymount is either the only beneficiary, or is one of a number of charities benefiting from the event.
Ideally include the percentage of income going to Marymount. Messaging must be as transparent as possible.

Please submit all revenue from the event to Marymount within 30 days of the event. You can donate directly to the
bank using the details below, post in cheques, bank drafts & postal orders or over the phone with a card.
Bank: AIB Account Name: Marymount University Hospital and Hospice
IBAN: IE36AIBK93410007056459 BIC: AIBKIE2D
NOTE: If you lodge money directly please make it clear on narrative either your name or the event title and call us
in the office to confirm lodgement and to supply us with details for acknowledgement letter.

The organisers will not represent themselves as having any agency relationship for Marymount.

Requests to attend your events. Please note we are a very small team based in Cork and may be unable to attend.
We have a panel of Friends of Marymount Volunteer Representatives that may be able to attend on our behalf so
please ask if you would like this. Please give as much notice as possible and we will try our very best for you but
this may not always be possible.

Please return the form overleaf completed to Marymount for approval before proceeding with an event on our
behalf.
We would like to again thank you for helping Marymount. We supported more than 3,000 families in the Cork area in
2016 and we need to raise €3 million each year outside of state support to continue to provide our needed services.
Your support is vital to our success.
Best of luck with your event!
The Marymount Team
Marymount, Curraheen, Co Cork,
W: www.marymount.ie E: [email protected] T: 021 4501201
Facebook.com/marymountuniversityhospice
@marymountcork