Host a community fundraiser or campaign!

We are excited to partner with you on your special event! Asante thrives because of community support and individuals like you. Your generous gift of time, talent and treasure is greatly appreciated. Now, let’s get started!

Please complete this form for our team to review. We will do our best to get back to you within 2-3 business days.

Third-Party Event/Campaign Proposal Application

Contact information
Name*
First Last
Company
Email*
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Detailed description of event/activity
Event/fundraiser name*
Description of event:*
Location name*
Fundraising activities for your event or campaign should take place in the community, not at any Asante facilities. All fundraising conducted on Asante campuses is done by the Asante Foundation.
Target audience*
Date of event*
Time of event*

: Hours

Minutes

AM/PM
Budget
Please tell us about your event and fundraising plan or attach a budget which addresses the following: Planned sources of income (sales, sponsorships, donations, etc.), estimated expenses and estimated donation to Asante Foundation (please indicate the amount and the basis for the donation (i.e. the percentage of proceeds to be donated.) *Ideally expenses should not exceed one third to one half of the gross revenue.
Anticipated donation amount*
Anticipated date donation will be received by Asante Foundation*
Designation of funds*
Which initiative is important to you?
Please indicate designation*
Promotion
Please submit all promotional materials that include the Asante Foundation name or logo to be reviewed before production. The third-party organization is responsible for media relations around their event, however, Asante Foundation is happy to leverage the stories on its blog or reshare on social media channels.
List all forms of promotion (Print, TV, radio, online, other)*
Insurance/liability
Name of insurance carrier and amount of coverage
This will not be applicable for all events.
Needs from Asante Foundation
Asante Foundation can provide you with informational brochures, logos, patient stories and ideas. Depending on the nature and needs of your event, we may be able to provide more assistance. Please let us know your needs.
Asante Foundation can provide you with informational brochures, logos, patient stories and ideas. Depending on the nature and needs of your event, we may be able to provide more assistance. Please let us know your needs.
Any additional comments
Would you like to subscribe to our email list?
- Yes
Third-Party Fundraising Contract*
Third-Party Fundraising Contract

Please read the following and keep a copy for your records.

You make a difference. Thank you for selecting us as the beneficiary of your event. We are honored you have committed your time and effort into supporting Asante and Asante Foundation. Please carefully read the guidelines below and complete the required signature portion. Thank you.

1. Your fundraising event should fit the mission and promote the appropriate image of Asante.

2. Please wait to make any public announcement or promote the event until Asante Foundation has been notified and you receive our confirmation. Asante Foundation must approve: Fundraising activities, Use of the name or logo of Asante and Asante Foundation, and Promotional materials including: Press Releases, Posters/Flyers and Invitations.

3. Once your proposal is approved, printed materials and other information should state “Proceeds will benefit…” or “An event benefiting,” For example, “proceeds will benefit Asante Foundation” or “an event benefiting Asante Foundation.”

4. Asante Foundation may be able to share your event date and details with volunteers and other contacts but assumes no responsibility for promoting the event.

5. Asante Foundation makes no guarantees to supply Foundation staff or volunteers for the event. Please contact Asante Foundation as early as possible in order to have your event on our calendar.

6. For confidentiality reasons, Asante Foundation cannot release donor, volunteer, employee, physician or other mailing lists for the purpose of additional solicitation of funds by an individual, company, group or organization.

7. If circumstances warrant, Asante and/or Asante Foundation may opt out as the beneficiary of the event at any time with no obligation.

8. The sponsor/organizer/organization holding an event intended to benefit Asante and/or Asante Foundation agree to indemnify, defend and hold Asante and Asante Foundation harmless against and in respect of any and all claims, demands, losses, costs expenses, obligations, liabilities damages, recoveries and deficiencies, including interest, penalties and reasonable attorney’s fees that shall be incurred or suffered by Asante and/or Asante Foundation which arise, result from or relate to applicant’s fundraising event or fundraising program, applicant’s performance of the agreement as specified in these guidelines and Asante Foundation Third-Party Fundraising Form.

9. If a professional fundraiser or promotions person is hired to coordinate a special event that benefits Asante and/or Asante Foundation, please notify Asante Foundation office. The organizer hereby agrees to adhere to all federal, local and state laws and assure that compensation to any professional fundraiser or promoter shall not be based on commission or percentage of monies raised.

10. Asante Foundation cannot be liable for any expenses incurred by an individual or any organizations involved in fundraising on behalf of Asante and/or Asante Foundation.

11. Asante Foundation does not advance monies or solicit sponsorship revenue for outside fundraising activities.

12. The event sponsor/organizer/organization agrees to keep the expenses to less than fifty percent (50%) of the total raised. Ideally expenses should not exceed 1/3 of the gross revenue.

13. Oregon law requires special licensing to conduct a raffle. If you or your organization would like to conduct a raffle, individuals and/or organizations must obtain a raffle license from the Oregon Department of Justice.

14. In accordance with IRS regulation, the individual or organization conducting the fundraiser is responsible for disclosing to donors any net or percentage amounts of their gift, which will be donated.

15. According to IRS Codes, all tickets, invitations or entry forms state what portion of the contribution is tax deductible. (Example: Dinner ticket is $75. Dinner fair market value is $15. The $15 is not tax deductible.) Donors must be notified of the fair market value of prizes and auction items.

16. Within 60 days of the last day of the fundraising event/promotion, please send a final accounting of income and expenses along with your check to Asante Foundation. Checks can be made payable to Asante Foundation 229 N. Bartlett St, Medford, OR 97501.

I/we have read the Asante Foundation 3rd Party Fundraising Contract and understand them as written. I/we understand that Asante and Asante Foundation do not accept or assume liability for this event.
I agree
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