Host a Friends Like Me Drive Registration Form

Who is conducting the donation drive? (i.e., name of organization, neighborhood, family, business, church)*
Drive Start Date
Date Format: MM slash DD slash YYYY

(an approximate start date is fine)
Drive End Date
Date Format: MM slash DD slash YYYY

(an approximate end date is fine)
Contact Name*
First Last
Contact Email*
Contact Phone*
Is this a public drive?
- Yes
- No
Please check to verify that the event will benefit the PBCC*
- I've verified that this event will benefit the PBCC
Name
This field is for validation purposes and should be left unchanged.