Fundraiser Group Name (required)

Group Leader's Name (required)

Group Address

Street (required)

City (required)

State (required)

Zip (required)

Home Phone

Cell Phone

Group Leader Email (required)

Number of Participants in the Group


Need Printed Forms?

NoYes

All funds sent from your group will be listed as you have selected below.
Please choose one OR the other.
All Funds to WAA-HFundraising to get money back

Rebate Address (required)
Use Same Address as Above?

NoYes
(If Yes, no need to re-enter address)

Street

City

State

Zip

Are you a 501 (c3) organization?
NoYes

Fundraising Goal for 2018

Security Code