Survey - Host Your Own - Mount Sinai Health System

Constituent Information

*

Name:

First Required	Last Required

*

Email: Required

Street 1:

Street 2:

City/State/ZIP:

City	State	ZIP

*

Phone Number: Required

Yes, I would like to receive e-mail from Mount Sinai Health System

Yes, I would like to receive postal mail from Mount Sinai Health System

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Question - Not Required - Event Name

Question - Not Required - Event Date

Month

Day

Year

Question - Not Required - Organization Name

*

Question - Required - Are you a 501(c)3 organization?

Yes

No

Event Location

Question - Not Required - Venue/Location Name

Question - Not Required - Street Address

Question - Not Required - City

Question - Not Required - State

Question - Not Required - Zip

Question - Not Required - Event Description

Maximum response 255 characters, approx. 5 rows of text

Question - Not Required - What area of the Mount Sinai Health System is the event benefiting?

Maximum response 255 characters, approx. 5 rows of text

Question - Not Required - How do you plan to fundraise for your event?

	Ticket Sales
	Outright Donations
	Sponsorships
	Auction
	Other

Question - Not Required - Is your event:

Open to the public

Invitation Only

Question - Not Required - Is Mount Sinai the sole beneficiary of your event?

Yes

No

Question - Not Required - If no, which organization(s)?

Maximum response 255 characters, approx. 5 rows of text

Question - Not Required - Are you interested in an online donation page for your event?

Yes

No

Estimated Event Revenue

Question - Not Required - Estimated Event Income($)

Question - Not Required - Estimated Event Expenses($)

Question - Not Required - Estimated Net Revenue($)