B4B Group Fundraiser Registration

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Upon registration you will be contacted by a Group Fundraiser Account Manager. At that point he or she will explain the program in greater detail and answer any questions you (or your group) may have.

Your group must be a recognized group, team or organization within the school you are enrolled. Any misrepresentation of a group will result in immediate termination from this program.

Please be sure to fill out this application in its entirety to ensure an expedient approval process.

Group Information

Group Name
Number of Members	Less than 20 20 ~ 50 50 ~ 100 More than 100
School
Telephone	( ) -
Email Address
Confirm Email

Payment Address 1
Payment Address 2
City or Town
State	Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Federated States Of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Armed Forces Pacific
Postal Code
Your Local Hub	None Buffalo - Elmwood

Account Information

First Name
Last Name
Your Position
Year	Freshman Sophomore Junior Senior Super Senior Graduate Student Masters Student
Type of Fundraiser	Standard 50/50 Make a Difference
Your Charity	None Read to Succeed Buffalo Rochester Education Foundation (REF) Family Literacy Centers, Inc Reading Is Fundamental of Southern California
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