Survey - Community Partner Event Registration - Cook Children's Health Foundation

Community Partner Event Registration

1. About you

Field Is Required Title

Field Is Required First

Field Is Required Last

Field Is Required Date of Birth:

Field Is Required Street 1:

Field Is Required City/Town:

Field Is Required State / Province:

Field Is Required ZIP / Postal Code:

Field Is Required Email:

Field Is Required Phone Number:

2. Field Is Required What is your preferred method of communication?

3. Field Is Required What is your connection to Cook Children's? Please make at least 1 selection from the choices below.

4. Field Is Required What area of Cook Children's interests you the most? (Select one of the available choices or enter a different value.) What area of Cook Children's interests you the most? Click this to indicate that you will select an existing value. Tab to next input." What area of Cook Children's interests you the most? What area of Cook Children's interests you the most? Click this to indicate that you will enter a new value. Tab to next input." What area of Cook Children's interests you the most? Provide your answer here

5. Field Is Required Fundraiser Type (Select one of the available choices or enter a different value.) Fundraiser Type Click this to indicate that you will select an existing value. Tab to next input." Fundraiser Type Fundraiser Type Click this to indicate that you will enter a new value. Tab to next input." Fundraiser Type Provide your answer here

6. Field Is Required Please describe your event.

Please read the following terms and conditions. You must accept the terms in order for your fundraiser to be considered.

Terms and Conditions

7. Field Is Required I accept the terms and guidelines.

8. Will you need a website for your fundraiser?