Survey - DIY Fundraising - Create Your Own Virtual Event

Please fill out the following survey so we can learn a little bit more about your event.


*	First Name: Required
*	Last Name: Required
*	Email: Required
*	Street 1: Required
*	City: Required
*	State / Province: Required
*	ZIP / Postal Code: Required
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Question - Not Required - Home Phone

Question - Not Required - Cell Phone:

*

Question - Required - What is your connection to Duchenne/Becker?

*

Question - Required - Please tell us what kind of event you are thinking of holding.

*

Question - Required - What month of the year are you looking to hold your event?

*

Question - Required - Do you have a location?

*

Question - Required - Have you held an event like this before?

Question - Not Required - Are there any other comments you'd like to share?