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Registrant Form - Do it in the Dark 2022 Fundraiser
Date: March & April 2022

Organised by: Retina Australia

Phone: 1800 999 870 or (03) 9560 5088

Email: info@retinaaustralia.com.au

Website: www.retinaaustralia.com.au
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Full Name *
Phone Number *
Date of Birth
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How should we send your Fundraising Kit? *
Required
What is your mailing address? ( You need to provide this so that we can send the glasses) *
When do you expect to run your event? *
Required
What type of event do you plan to host? *
Will your event be run from home, at the workplace or virtually? *
What is the address of where you will host your proposed event? *
Will you create a 'Just Giving' supporter page? Creating a Just Giving page will ensure more donations & enthusiasm from your supporters. *
How many people will attend your event approximately? *
By registering for the Do it in the Dark 2022 fundraising event, I have read the relevant resources on the Retina Australia website detailing the fundraiser and understand the conditions of hosting an event for the organisation.   *
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