Test – Hits for the Cure

"*" indicates required fields

Your Name

First Last

Email*

Phone*

Fundraiser*

Choose the Fundraiser you would like to donate to.

Team Name*

Select the Team you would like to apply your Donation to.

Your Donation 'Per Hit'*

Average amount of hits per event is around 400. Donating $0.10 per hit would be a donation of $40.00. (# of Hits * Donation Amount = Total)

Credit Card*

Card Details

Cardholder Name

Address*

Street Address City State ZIP Code

Holding Fee

Price:

This charge is so we can verify the card information and safely and securely store your credit/debit card information until the end of the season.

Confirmation*

I confirm everything is correct.