Fundraising Page 2 - Young Hearts For Life® Cardiac Screening Program : Young Hearts For Life® Cardiac Screening Program

Organization (if applicable)*
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Phone*
I would like to raise money for Young Hearts for Life's*
- General Fund
- Research
- Memorial Fund
Event Name & Location*
Event Description & Reason for Selecting Young Hearts for Life:*
Date*
Date Format: MM slash DD slash YYYY
Time*

: HH

MM
Ticket Price:*
How will you promote this event? (Please include any media partners)*
Do you anticipate this being an annual event?*
- Yes
- No
Are there other beneficiaries? If yes, please list them:*
Estimated revenue?*
Estimated donation?*
Do you plan to seek donations from local organizations? If yes, please list them:*
What do you need from YH4L?*
I have read and agree to follow the YH4L fundraising guidelines*
- Yes
- No
Name*
First Last
Date*
Date Format: MM slash DD slash YYYY

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