Fundraising Activity Registration

Phone

This field is for validation purposes and should be left unchanged.

I am registering(Required)

An optometry practice

A business or organization

An optometry student group

Country(Required)

United States

Canada

Other

Practice name as you would like it to appear publicly(Required)

Business/organization name as you would like it to appear publicly(Required)

Name of school as you would like it to appear publicly(Required)

Name of student organization as you would like it to appear publicly(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Address(Required)

Street Address Address Line 2 City Province Postal Code

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Individual who should receive information about your participation in the World Sight Day Challenge(Required)

Prefix First Last

Job Title(Required)

Email(Required)

World Sight Day Challenge kit

Yes, please send me a World Sight Day Challenge kit to help promote my fundraiser and recognize donors.

Setting a fundraising goal can help create excitement for your activity. What would you like your goal to be?(Required)

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