Brighter Berkshire Pledge Form
This form will capture pledges from individuals, teams, organisations, groups that are being made for Brighter Berkshire with the aim of increasing the conversation and awareness of mental health for 2017 Year of Mental Health.

We are also hoping to raise a significant amount of funds through this campaign to go directly to charities and initiatives identified through the year as having positive impact on mental health. If the fund is big enough it can be turned into a foundation which through the interest can pay out year on year to local initiatives.
Email *
Name (how you would like it displayed on web)
Postcode (so we can display pledge numbers and details on a map)
Team or organisation name if applicable
My Personal Pledge/s
I am making this pledge/s because
I hope the difference it makes will be that
My Team, Organisation or Group Pledge/s
We are doing this because
We hope the difference it will make is
Our leader (insert name and role) has made the following quote
I would describe my role in Brighter Berkshire as
I am interested in joining the following buddy groups
I have some other comments, suggestions or ideas I would like to share
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy