Register Fundraiser

Name*
First Last
Email*
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Event Information
Name of event*
Date*
Date Format: MM slash DD slash YYYY
Time*

: HH

MM
Event location*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Website where event will be publicized
Brief description of event
Event beneficiary*
- Sakinah Medical Outreach is the sole beneficiary of this event
- This event benefits more than one organization
Expected number of attendees*
Fundraising goal*
How did you hear about Sakinah Medical Outreach?*
Email Updates
- I would like to receive email updates
Please enter email to receive updates*
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Waiver*
- I understand that my event is considered a Third-Party Event by Sakinah Medical Outreach and I agree to adhere to the guidelines
Signature
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Event Information