Children taking a stand

WE TOOK A STAND AGAINST CHILDHOOD CANCER THIS SEPTEMBER

Name of Participating Child*

First NameLast Name

Name of Parent

First NameLast Name

Parent Email

example@example.com

Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Total Amount Enclosed (if mailing in)

Brief Description of Event

SUBMIT DONATION ONLINE HERE (Skip this step if submitting via mail)

USDDescription

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

*All participating children will be automatically entered to win an Amazon gift card ($25 value). Forms with payment must be received by October 30, 2022. Winners will be selected at random and announced on November 1, 2022. There is no minimum fundraising requirement to be entered, and selection will not be weighed according to fundraising success.

IMPORTANT REMINDERS:

Cash must be deposited or converted to a bank check or money order before mailing in via check, payable to the Ty Louis Campbell Foundation.
All funds collected should be mailed to the address below within 14 days of event completion of fundraising activity ALONG WITH A COPY OF THIS FORM.
Email any questions to info@superty.org

The Ty Louis Campbell Foundation
Take A Stand September Team

1787 Route 6
Carmel, NY 10512