Title
—Please choose an option—Mr & MrsMrMrsMsDrProfMissSir
First Name
Last Name
Are you doing this on behalf of a company?
—Please choose an option—YesNo
[group company-name]
Company Name
[/group]
Email
Phone (please include your area code)
Have you raised funds for the ACRF before?
Name of Fundraiser/Event
Description of the activity or event including venue or location
Proposed date / timeframe of your fundraiser
Support ACRF in its mission to back brilliant cancer researchRelative or friend affected by cancerI have personally been affected by cancerOther
How much money do you aim to raise for the ACRF?
—Please choose an option—$1 - $999$1,000 - $4,999$5,000 - $9,999$10,000 or more
Are you over 18?
Tick to confirm that you have read and agree to abide by fundraising guidelines and legislation (found on the right of this form).
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