MS Mega Challenge : Register

First Name *

Last Name *

Email Address *

Password*

Mobile *

Date of birth *

Gender *

YOUR OFFICIAL EVENT ENTRY PACK WILL BE SENT TO THIS ADDRESS

(enter manually)

UnitStreet Number *

Street *

Town/Suburb *

Postcode *

State *

Country *

First Name *

Last Name *

Contact Number *

Relationship to you

RAISE OVER $75 AND START EARNING SOME AWESOME REWARDS!

MINIMUM FUNDRAISING TARGET IS $150

Fundraising Target *

$

No Thanks Join Create

Relationship to MS *

Reason for Registering *

BY SHARING YOUR INFORMATION, YOU AGREE TO RECEIVE COMMUNICATIONS FROM US. WE WILL KEEP YOUR DATA SAFE IN ACCORDANCE WITH OUR PRIVACY POLICY.

IF I RAISE $75 OR MORE, PLEASE DO NOT SEND ME AN MS FUNDRAISING REWARD.

TEAM TYPE

I AGREE TO TRY AND RAISE FUNDS TO SUPPORT PEOPLE LIVING WITH MS *