Cause Marketing Application

Application Instructions: Please fill out and send completed form to summer.marten@lpfch.org or fax to (650) 498-2619. Please allow 2 weeks for a response.

Company Information:

First Name (Contact) *This question is required.

Last Name *This question is required.

Name of Organization *This question is required.

Phone Number *This question is required.

Fax This question requires a valid number format.

Email Address *This question is required.

Mailing Address *This question is required.

Apt/Suite/Office

City *This question is required.

State *This question is required.

Zip *This question is required.

Company Website *This question is required.

Social media presence (Facebook, Twitter, Instagram, etc.) *This question is required.

Promotion/Product Information

2. Description of Promotion/Product: *This question is required.

3. Describe how revenue will be generated through this promotion: *This question is required.

4. Date(s) and duration of promotion: *This question is required.

5. Describe your company's objective for this promotion: *This question is required.

6. Portion of sales from each item to be donated: *This question is required.

7. If there is a maximum donation limit, please state the maximum here: *This question is required.

8. Are there other beneficiaries of this event? *This question is required.

Please enter an 'other' value for this selection.

9. Publicity: Plan for publicity (All materials must be reviewed and approved in advance by the Foundation) *This question is required.

Press Releases to be sent to: Please enter an 'other' value for this selection.
Flyers to be distributed to: Please enter an 'other' value for this selection.
Public Service Announcement to be distributed to: Please enter an 'other' value for this selection.
Other: Please enter an 'other' value for this selection.

10. I plan to submit the funds by *This question is required.

Please enter an 'other' value for this selection.

11. Payment Schedule: *This question is required.

Please enter an 'other' value for this selection.

12. Funds can be designated to the Children's Fund: *This question is required.

Please enter an 'other' value for this selection.

13. Polices and Procedures acknowledgement

14. I specifically agree to all the terms and conditions contained in the “Policies and Procedures for Cause Marketing Fundraisers” attached to and made a part of this application. I understand that my promotion is not considered an approved promotion until written approval of my application is received from the Foundation. No amendment, modification or waiver of any of the terms and conditions contained in this document and the “Policies and Procedures for Cause Marketing Fundraisers” shall be valid unless in writing.

At no time will the Foundation, or any representative of the Foundation, be responsible for the cost, planning, or staffing of my promotion, nor will they be liable for personal injuries or damages to property which may occur. I agree to indemnify and hold harmless Lucile Packard Children’s Hospital Stanford, Stanford University School of Medicine, and the Lucile Packard Foundation for Children's Health and their employees, agents and representatives, from any and every claim, demand, suit and payment related to or caused by my promotion.

By signing here I confirm the above to be true.

Date: __________________

Title: _________________________________ *This question is required.

Clear

Signature of

15.
Brian Perronne
Chief Operating Officer and Senior Vice President, Development
Lucile Packard Foundation for Children's Health

Date: _____________________________

Signature: