Name: 

Title or Position:

Oraganization Name:

Address:

City:

State:
Zip:  

Address 2:

Email*:

How many participants do you expect in your fundraising campaign? (ie number of children in your class/school or members of your organization

Phone (D):

How much money are you trying to raise in this campaign

Phone (E):

When do you expect to begin your NEXT fundraising campaign?

Within 30 days Within 30 days - 3months Within next 3-6 months Within next 6 - 12 months Campaign is ongoing Not sure

Fax:

Comments: