Will you be promoting your event? *

Would you like to have WellSpan Health Staff/Board of Directors participate in your event? * Yes No

Which of the following will you be using to publicize your event? * Internal promotion such as newsletters Posters/Flyers Advertisements Public Service Announcements Other

What is the estimated duration of the promotional activities? *

What is your estimated net revenue for this event? *

TERMS AND CONDITIONS

I/We have read the Event Guidelines and, if this proposed activity is approved by WellSpan Health and WellSpan Philanthropy, we agree to abide by all conditions set forth in the event guidelines and/or outlines specifically for this proposed activity.

Specifically, I/We agree that:

• The named “person in charge” of proposed activity has the authority to enter into this agreement. WellSpan Health and WellSpan Philanthropy are not responsible for any debts or costs incurred as a result of this activity. I/We agree to hold WellSpan Philanthropy and WellSpan Health harmless against the action of any creditors. In addition, the applicant agrees to appropriately handle and safeguard all funds received, and in a timely manner, deposit the proceeds intended for the WellSpan Health beneficiary and transfer those funds to the appropriate WellSpan Philanthropy office for processing.
• Any printed materials, press releases, etc. mentioning WellSpan Philanthropy or WellSpan Health will be submitted for approval prior to use. I/We further understand that approval of proposed activity does not constitute permission to use WellSpan Philanthropy or WellSpan Health logos in any materials, as such use is restricted to entity-sponsored events.

Terms accepted by:

Signature of Applicant *