The Smile Centre's Individual Giving Scheme
The Smile Centre
39 Church Street
Liskeard, Cornwall
PL14 3AQ

Thank you for applying to The Smile Centre's 'Individual Giving' scheme. We are excited about supporting our patients and friends in their fundraising efforts and hope we will be able to support you in achieving something special.

The Smile Centre allocates £500 per year to the Individual Giving Scheme. You are invited to apply for a maximum of £100 to support you in your venture, whatever it might be!

This application form is for individuals only; if you are a charity or a community project, please refer to our other application form entitled 'Local Giving'.

Today's date:

Your full name:                                          Tel:

Cause for which you are raising funds:

Target amount:                                   

Amount being requested from The Smile Centre:

Deadline by which funds must be raised:

Activity you will be undertaking to fund raise for your cause:

Can you confirm that all the necessary insurance cover is in place for you to carry out this activity Y / N

Would you be willing to wear a Smile Centre t-shirt? (this is in no way obligatory, and will not affect our decision to support you in any way) Y / N

Would you like your event to be mentioned in our newsletter and/or on our website? Y/N

Signature:

Thank you for applying to the TSC Individual Giving Scheme. We will be in touch within one month to let you know if we can help. Good luck!