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Fundraising Page Information
Campaign Title
*
Page Link
*
Text entered in this field will be used as the final portion of your page's URL.
Custom page link requirements: only letters, numbers, dashes, or underscores.
Your page link:
https://www.mysmiletrain.org/campaign
/
Campaign Date
*
Show a date for your campaign on your fundraising page.
Fundraising Goal
*
$
Make a Donation
*
Yes! I’d like to make a donation toward my fundraising goal.
No thanks.
Donation Amount
*
$50
$125
$250
$500
$1,000
Other
A minimum donation of $5.00 is required.
$
Registration Questions
How did you learn about Team EMPOWER
*
[Select...]
Referred by friend
Previous Team EMPOWER Participant
Race Website/ Google Search
Social Media (Facebook, Instagram, Twitter)
Race Expo or Postcard
Smile Train Donor
Employer/ Corporate Partnership
Other
Referral Name
Birthday
*
(ex: mm/dd/yyyy)
Emergency Contact Name
*
Emergency Contact Phone Number
*
(ex: 123-123-1234)
Employer Name
*
Team dri-fit t-shirt size?
*
[Select...]
Women's Extra Small
Women's Small
Women's Medium
Women's Large
Women's Extra Large
Women's XXL
Men's Small
Men's Medium
Men's Large
Men's Extra Large
Men's XXL
Men's XXXL
No Shirt
Do you have a personal connection to cleft?
*
I was born with a cleft
My son/daughter was born with a cleft
A close family member was born with a cleft
I have worked with people with clefts
Someone I know was born with a cleft
I don’t know anybody with a cleft
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