Contact
Celebrate for CHOP
Fundraising Page Information
Page Title
*
Page Link
*
Text entered in this field will be used as the final portion of your page's URL.
Custom page link requirements: only letters, numbers, dashes, or underscores.
Your page link:
https://chop.donordrive.com/campaign
/
Campaign Date
*
Show a date for your campaign on your fundraising page.
Fundraising Goal
*
$
Make a Donation
*
Yes! I’d like to make a donation toward my fundraising goal.
No thanks.
Donation Amount
*
$
Registration Questions
Gender
[Select...]
Male
Female
Prefer not to say
Date of Birth (mm/dd/yyyy)
*
(ex: mm/dd/yyyy)
Company Name
Please select which is most relevant to your experience with Celebrate for CHOP?
*
[Select...]
I am an immediate family member.
I am an extended family member.
I am a current or former CHOP patient.
I am supporting a friend who is a patient at CHOP.
I am a CHOP employee.
What are you celebrating?
*
Birthday
Wedding
Baby Shower
Anniversary
Bar/Bat Mitzvah
Other
What is the date of the birthday you're celebrating?
What is the date of the wedding you're celebrating?
What is the date of the baby shower you're celebrating?
What is the date of the anniversary you're celebrating?
What is the date of the bar or bat mitzvah you're celebrating?
If you selected "Other" please tell us what you are celebrating
What is the date of the event or milestone you're celebrating?
My page is:
In memory of
In honor of
Honoree First Name
Honoree Last Name
Honoree First Name
Honoree Last Name
My relationship to the honoree is:
[Select...]
Parent
Spouse
Child
Grandparent
Friend
Other
If you selected "Other" above please specify
I would like donations made to my fundraising page to support:
*
The Children’s Fund (Greatest Need)
A specific area of the hospital
Please list the area of the hospital you wish to support.
What motivated you to create a Celebrate for CHOP fundraising page?
*
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