How can you help?
....Organise a Fund Raising Event
FUNDRAISING REGISTRATION FORM
Please fill out the form below or alternatively you can print a page here

CONTACT NAMES:
Please provide two contact names (principle organisers)

Name: __________________________

Address: __________________________
__________________________
__________________________

Phone No.: __________________________ Home
__________________________ Mobile
Name: __________________________
Address: __________________________
__________________________
__________________________
Phone No.: __________________________ Home
__________________________ Mobile

Proposed Fundraising Idea: ____________________________________________
____________________________________________
____________________________________________
Location of Fundraising: ____________________________________________
Proposed Date of Event: ____________________________________________

Estimated Number of Participants Involved: __________________________

Fundraising Target €_________________ if applicable

Preferred Method of Money Transfer
□ Lodgement Direct to the Friends Bank Account

□ Official Presentation to a member of the Friends Group

Return to:
Friends of Wexford General Hospital,
P.O. Box 10, Anne Street, Wexford
Or register online at www.friendsofwexfordhospital.ie