Event Registration and Information Form | Centrepoint

"> Title

"> First name

"> Last name

"> Date of birth

"> Email address *

"> Contact number

"> Which region are you from? *

"> Date of event (if known)

"> Event description *

"> Tell us more...

"> If other, please specify

"> How much are you hoping to raise? *

"> How did you hear about Centrepoint? *

"> If other, please specify *

"> Why did you choose to fundraise for Centrepoint?

"> By submitting this form, I'm happy to be contacted by email about this event *

By submitting this form, I'm happy to be contacted by email about this event * (Please provide a value for By submitting this form, I'm happy to be contacted by email about this event)

"> I'm happy to be contacted by email about other ways to support Centrepoint

I'm happy to be contacted by email about other ways to support Centrepoint

"> I'm happy to be contacted by phone about this event and other ways to support Centrepoint

I'm happy to be contacted by phone about this event and other ways to support Centrepoint

"> I'm happy to be contacted by text (SMS) about this event and other ways to support Centrepoint

I'm happy to be contacted by text (SMS) about this event and other ways to support Centrepoint

ARE YOU HOMELESS, SOFA SURFING OR AT RISK?

REGISTER YOUR FUNDRAISER