EmailMe Form - Fundraiser Submit Form

Fundraiser Title *

Date Time
What day and time
Event takes place *

MM / DD / YYYY HH : MM AM/PM

Where the Event will take place *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Describe your event
Include cost or any special notes *

% of this event will go to American Cancer Society *

Please give us an idea of the % of your event will be donated to Relay. Note: Radio stations have requested that we NOT submit any fundraiser with less than 50%. We will put all on Facebook, Twitter, Newsletter and our website.

Team Name *

Contact Person *

First Last

Contact Number *

### - ### - ####

Contact Email Address

Photo or Poster to add