Pledge by EventWell® Application Form

Full Name(required)

Email(required)

Phone(required)

Have you applied for a pledge before?(required) Yes

No

What pledge is it that you are looking to redeem?(required) Small Grocery Shop (£25)

Medium Grocery Shop (£50)

Family Grocery Shop (£75)

Child Gift/Present (£25)

Child Care Package (Clothing & Accessories) (£25)

Child Care Package (Clothing & Accessories) – 2 children (£50)

Child Care Package (Clothing & Accessories) – 3 children (£75)

Hardship Relief Grant (£ on application)

Professional Counselling/Therapy – 1 Hour (up to £65)

Other

If you are applying for a hardship relief grant or other please provide details

Please advise your preferred retailer if you selected a grocery shop pledge

What are your work circumstances?(required)

What is/was your role in the Events Industry (or creative, marketing, travel or hospitality)?(required)

What are your personal circumstances?(required)

Do you have children, please tell us how many?(required)

To support your application please can you provide us with some brief details on why you are seeking support from Pledge by EventWell?(required)

Where are you based?(required)

If Other please state where?

When would you like to redeem?

How did you hear of us?(required)