Fundraise at school

Support Number (If known)

School/Centre name*required

School type*required

Title*required

Primary Contact*required

Position*required

Primary contact email*required

Mailing Address*required

Suburb*required

State*required

Postcode*required

Business phone

Mobile Phone*required

Fax

School/centre email

History of school/centre participation*required

Our school/centre's Jeans for Genes day will be held on*required

Number of students involved?*required

MEDIA OPPORTUNITIES

Our school/centre is interested in a Jeans for Genes Day story in the local newspaper*required Yes No

Our school/centre gives approval for the publicity and media team to contact us and arrange a photo shoot and/or interview students*required Yes No

Our school/centre has a student or family who may be interested in sharing their personal story regarding genetic disorders*required Yes No

Our local area newspaper is

Additional comments or questions?

Mandatory field(s) marked with *