ࡱ> uwt RbjbjcTcT vX>>$  GGL*]]]ut@ h)))))))$-}0J)uttt)GG]uS;*:F F F t4G8]u)F t)F F rh(Th)];Y(()u*H*(0v0h)0h)$ttF ttttt))F ttt*tttt0ttttttttt :  HYPERLINK "http://www.torontomeds.com/imagine/" \o "Home page"  INCLUDEPICTURE "http://www.torontomeds.com/imagine/img/v2logo-345x103.gif" \* MERGEFORMATINET  Executive Member Application Form FUNDRAISING CHAIR PART A: Information Date of Application (DD-MM-YY):  FORMTEXT        First Name:  FORMTEXT      Last Name:  FORMTEXT       Sex:  FORMCHECKBOX Male  FORMCHECKBOX  FemaleProfession-Specific Information Program:  FORMDROPDOWN Year of Program:  FORMDROPDOWN Contact Information Phone no. (Home):  FORMTEXT      Email:  FORMTEXT       Phone no. (Cell):  FORMTEXT       Address:  FORMTEXT      City:  FORMTEXT       Province:  FORMTEXT      Postal Code:  FORMTEXT      In Case of Emergency (Emergency Contact) Name:  FORMTEXT       Relationship to Applicant:  FORMTEXT       Phone Number: (Home):  FORMTEXT       (Work):  FORMTEXT       PART B: Roles and Responsibilities The Fundraising chair is responsible for identifying and securing funding for the IMAGINE initiative, as well as building sustainable relationships with current financial supporters. One (1) position is currently open Duties include: Researching and managing new grant applications and renewal of previously awarded funding Developing strategies to contact and present to potential funders Pursuing donations and support from the private sector, professional organizations, government, etc. Organizing fundraising events for IMAGINE Questions? Contact RyanMcGuire:  HYPERLINK "mailto:ryan.mcguire@utoronto.ca" ryan.mcguire@utoronto.ca PART C: Questions  FORMTEXT       Why do you want to become an Executive Member of IMAGINE? (Max 250 words) What skills and experiences do you have that you believe would be an asset to IMAGINE? (Max 250 words)  FORMTEXT       How did you first hear about IMAGINE?  FORMDROPDOWN  If Other, please specify:  FORMTEXT       PART D: Volunteer Agreement & Signature All of the information contained in this application is true and the misrepresentation of any part of this application will be just and sufficient cause for termination of my volunteer placement. I understand that I am not an employee of IMAGINE and that any duties that I perform are as a volunteer. I am confident that I can successfully fulfill the expectations, as outlined in Part C of this application. 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I consent to have a picture/videotape/interview of me for the purpose of obtaining material which may be used in a brochure, internet web page, news story, feature or broadcast for promotional material for the IMAGINE Clinic.  FORMCHECKBOX  Yes  FORMCHECKBOX  No If accepted as a volunteer I agree to follow the above. Name of Applicant: _______________________________________ Date ___________________________ DD-MM-YY PLEASE BE ADVISED THAT YOU WILL BE REQUIRED TO SIGN THIS APPLICATION AT A LATER DATE Signature of Applicant: ____N/A for Now_______________ Date _____N/A for now________ DD-MM-YY THANK YOU for applying to volunteer with IMAGINE. 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