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3rd Party Fundraising Host

1. Name of Primary Contact

If you have previously registered, please to prepopulate your information.

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Name:

 

 

 

     

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City/State/ZIP:

 

    

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Date of Birth:

 

If you respond and have not already registered, you will receive periodic updates and communications from Brent's Place.

 

What's this?

*2.  


3.
Question - Not Required - Date of Event




*4.  


5.  


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7.

(Maximum response 255 chars, approx. 5 rows of text)

*8.

(Maximum response 255 chars, approx. 5 rows of text)

*9.
Question - Required - Will your event raise
Please make between 1 and 3 selections from the choices below.

*10.
Question - Required - Event is
Please make between 1 and 2 selections from the choices below.

*11.
Question - Required - Has the event taken place before?
Please make 1 selection from the choices below.

12.  


*13.
Question - Required - If possible, would you like to have someone from Brent's Place present at your event? Volunteer and staff attendance is upon request only and can only be considered if requested one month in advance. Brent's Place cannot guarantee staff, volunteers, or family attendance.
Please make 1 selection from the choices below.

14.

(Maximum response 255 chars, approx. 5 rows of text)

*15.
Question - Required - How will the event be publicized?
Please make between 1 and 8 selections from the choices below.

16.
Question - Not Required - Would you like to use the Brent's Place logo in any of your materials?

*17.  


*18.

(Maximum response 255 chars, approx. 5 rows of text)

19.

   Please leave this field empty

     

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