UnityPoint Clinic - Express (Jordan Creek)

Thank you for being a Shining Star and planning a FUNdraiser for Blank Children's Hospital. Please complete the form below to let us know about your fundraising activity or event so we can help make it even more successful...and FUN!

FUNdraiser Event Form

Fundraiser Contact Name:* Please check below for the Fundraiser Contact:18 or older
17 or youngerIf 17 or younger, please complete the info below:Name of parent/guardian, teacher or youth activities director:Name of school or organization (if applicable):Email address:Phone number:Home
Cell
OrganizationAddress:Home
OrganizationFundraiser/Event Name:Date:Time:Fundraiser/Event Description:Inspiration for Giving to Blank Children's:Where would you like the funds raised to go? (Certain program, service or department at Blank Children's)Do you have any questions or need additional information?Click submit below when finished. Thank you!

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