uspharma.online

1. Your Details
2. Your Fundraising Page
3. Kickstart Your Fundraising

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Personal Details

Title *

First Name *

Last Name *

Email Address *

Password *

Mobile *

Date of birth *

Postal Address *

When your fundraiser is approved, we’ll send you a digital welcome pack to get you started.

Address Line 1 *

Address Line 2 (opt)

Town/Suburb *

Postcode *

State *

Country *

Parent/ Guardian Permission Form

This form needs to be completed by the parent/guardian of any registrant who is under the age of 18. It must be submitted to enable your child/ a child in your care to take part in this event. National Breast Cancer Foundation (NBCF) takes the safety, privacy, and well-being of children and young people very seriously and your signed permission is necessary for NBCF to comply with our Child Protection Policy. For your child/a child in your care to take part in this event, your permission is needed for NBCF staff to:

Make direct contact with your child/a child in your care via email or phone (inc. by SMS) during the campaign period.
If you have any questions or concerns, you may contact the team on 1300 803 571 or via email at communityfundraising@nbcf.org.au

Your Privacy

At National Breast Cancer Foundation, we recognise the importance of your privacy and personal information. Our Privacy Policy is available on our website at www.nbcf.org.au/privacy.

You may contact our privacy officer with any queries via email: info@nbcf.org.au or mail: PO Box 4126 Sydney NSW 2000 or telephone: 1300 708 763.

This information will be stored securely on NBCF’s database.

Please tick the appropriate boxes below:

I have read the information provided above regarding the application of my child/a child in my care to participate in this event. *

I consent for NBCF staff to make phone/email contact with my child/a child in my care during the campaign period for the purposes of promotion and fundraising support. *

I would like SMS's and calls relating to this event to be directed to my mobile / home / work contact number below. Please specify your preferred contact number.

Child/Child in care's name *

Child/Child in care's date of birth *

Parent or Guardian's name *

Relationship to child

Parent / Guardian Contact Details

Mobile / Home Phone *

Email Address *

Date *

uspharma.online

Raised

$0

My Goal

$850

Joining Team uspharma.online11

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Personal Details

Postal Address *

Parent/ Guardian Permission Form

Parent / Guardian Contact Details

Call us on 1300 803 551

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