Survey - Event Proposal Form - University of Ottawa Heart Institute

1.

Question - Not Required - This event is being planned by an:

Individual

Organization

2.

Contact Information


*	First Name: Required
*	Last Name: Required
*	Email: Required
	Street 1:
	Street 2:
	City:
	Province / State:
	Postal / ZIP Code:
	Phone Number:
	Employer:
	Yes, I would like to receive email from University of Ottawa Heart Institute
	Yes, I would like to receive postal mail from University of Ottawa Heart Institute
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Please enter a user name and password for logging in when you return. You can use this password to update your information or receive personalized content.

*	User Name: Required	5 to 60 characters
*	Password: Required	12 to 99 characters
*	Repeat Password: Required

3.

Question - Not Required - Name of the proposed event

4.

Question - Not Required - Brief description of the proposed event

(Maximum response 255 chars, approx. 5 rows of text)

5.

Question - Not Required - What was the inspiration for the proposed event?

(Maximum response 255 chars, approx. 5 rows of text)

6.

Question - Not Required - Event Date:

Month

Day

Year

7.

Question - Not Required - Event time:

8.

Question - Not Required - Event location & address

(Maximum response 255 chars, approx. 5 rows of text)

9.

Question - Not Required - Will this be an annual event?

10.

Question - Not Required - Has this event taken place before?

11.

Question - Not Required - How many people do you anticipate will attend the event?

12.

Question - Not Required - How will the funds be raised e.g. ticket sales, raffles, pledges, etc.?

(Maximum response 255 chars, approx. 5 rows of text)

13.

Question - Not Required - Would you like the funds raised to be used for the Heart Institutes highest priorities or designated to a specific program or area within the Heart Institute?

(Maximum response 255 chars, approx. 5 rows of text)

The University of Ottawa Heart Institute Foundation receives many inquiries about charitable receipts and receipting. It is essential that all matters pertaining to charitable receipting are handled correctly and, most important, legally, following all Canada Customs and Revenue Agency guidelines

14.

Question - Not Required - Will your event require tax receipts?

15.

Question - Not Required - How do you plan on promoting the event?

	Brochures/Flyers
	Newsletters
	Personal Network
	Print Ads
	Radio Ads
	Social Media (Facebook/Twitter)
	TV Ads
	Other

16.

Question - Not Required - Do you require an electronic copy of our logo?

17.

Question - Not Required - Does your event require a gaming license?