Let us know all about your fundraising plans

Email (required)

We'll use this to contact you about your application.

Address line 1 (required)

Address line 2

Town (required)

Post code (required)

Country (required)

Phone number

We'll use this to contact you about your application.

How did you hear about Team Samaritans?

What type of fundraising are you planning? (required)

What date is your event? (required)

Please let us know when your event will be taking place. If it's multi day event, just tell us the start date.

Day

Month

Year

What is your date of birth?

Day

Month

Year

Please tell us about the event you would like to organise (required)

Do you have a Twitter account?

Enter your Twitter handle here.

Do you have a particular reason for supporting us?

Would you be interested in sharing your story?

If you're interested in sharing your story with our Media team, let us know.

What company do you work for?

Some companies offer matched funding, which could help you with your fundraising and help us support more people.

What's your role at your company?

Is your company eligible for matched funding?

Captcha (required)

Your address