Charity Campaign

Charity Registration Form

Thanks for taking the time to register your charity for our renewal program. We'll be contacting you shortly to let you know if you've been selected to participate. Please submit this form by 5pm on Friday, November 30th, 2012. Thanks :)

Charity Name *

Charity's domain name*

(ex. www.charitydomain.com)

Your Name *

First Name

Last Name

Email*

Phone*