Survey - Third Party Sponsored Event Application - University of Maryland Medical System Foundation

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Question - Required - Date of Application:

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Question - Required - Name of group/organization:

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Question - Required - Are you a(n):

	Employee Group
	Association/Organization/Club
	Corporation
	Other

Question - Not Required - If Other is selected, please specify:

Please list the main point of contact for your group/organization that is coordinating the event or promotion:

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Name:

First Required	Last Required

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Email: Required

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Street 1: Required

Street 2:

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City/State/ZIP:

City Required	State Required	ZIP Required

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Phone Number: Required

Yes, I would like to receive e-communications from UMMS Foundation.

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Question - Required - Date of Proposed Event:

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Question - Required - Times of Proposed Event:

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Question - Required - Location of Proposed Event:

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Question - Required - Please provide a brief description of the proposed event:

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Question - Required - What businesses, individuals or foundations will be approached for underwriting, sponsorship, in-kind giving, or other contributions to your event?

Question - Not Required - What incentives (if any) will be offered to sponsors for their participation?

Question - Not Required - Are additional promotional events planned to support the larger event? If so, please provide a description of these events:

Question - Not Required - Will there be a ticket or admission charge?

Question - Not Required - Amount for Ticket/Admission Charge:

Question - Not Required - Expected number of guests:

Question - Not Required - How and where will tickets be sold?

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Question - Required - Will the event benefit other organizations?

Question - Not Required - If Yes, please provide the names of other organizations:

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Question - Required - Percentage of net proceeds to be donated to UMMS:

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Question - Required - Expected donation to UMMS:

Question - Not Required - Please provide any additional details about your event for consideration:

Within sixty (60) days of the completion of the scheduled event, all net proceeds are to be delivered to:

UMMS Foundation
P.O. Box 64573
Baltimore, MD 21264-4573

I have read and agree to abide by and comply with all the terms and conditions in the above third party sponsored event guidelines. I understand that my proposed event is not considered approved until I have received written approval of my application from University of Maryland Medical System Foundation (UMMS Foundation). I agree to provide the proposed event in accordance with the approved Third Party Sponsored Event Application filed by me and approved by the UMMS Foundation. At no time will the UMMS Foundation or any representative of University of Maryland Medical Center or University of Maryland Medical System be responsible for the cost, planning, or staffing of my event. Either party may terminate this agreement upon at least sixty (60) days prior written notice to the other party. The University of Maryland Medical System Foundation reserves the right to disassociate it’s involvement with any group/individual or event who are not in compliance with the guidelines outlined in the Third Party Sponsored Events guidelines. Each party shall be responsible for its own acts and omissions and the acts and omissions of its employees, officers, directors and affiliates. A party shall not be liable for any claims, demands, actions, costs,expenses and liabilities, including reasonable attorneys’ fees, which may arise in connection with the failure of the other party to perform any of its obligations hereunder. The foregoing provision shall survive termination of this agreement. This agreement shall be governed by the laws of the State of Maryland. This agreement may only be amended or modified in writing signed by an authorized representative of both parties.

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Question - Required - By typing your name below, you are agreeing to the terms stated above.

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Question - Required - Today's Date:

Thank you for considering an event to support UMMC. All requests will be reviewed by UMMS Foundation representatives and answered in writing within ten (10) business days of receipt of a completed application.