Survey - 2024 Purple Partner Interest Form - Lupus Foundation of America

2024 Purple Partner Interest Form

Thank you for your interest in joining the fight against lupus and going Purple For Purpose!
We are grateful for our Purple Partners for creating opportunities for the public to donate, purchase products and support programs that benefit the Lupus Foundation of America.
Thanks for joining our mission to raise awareness and funds to support lupus research and education for the millions touched by this devastating disease.

Company Representative or Individual Name

Name:

First Required	Last Required

Email: Required

Street 1: Required

Street 2:

City/State/ZIP:

City Required	State Required	ZIP Required

Country: Required

Phone Number:

Employer: Required

Yes, I would like to receive e-mail from Lupus Foundation of America

Yes, I would like to receive postal mail from Lupus Foundation of America

Keep me logged in. What's this?

*2.

Question - Required - How are you participating? As a(n):

*3.

Question - Required - Describe how you would like to participate in Lupus Awareness Month (ie "We are going to donate 10% of proceeds," "We will allow customers to Round Up their purchases," etc.):

*4.

Question - Required - Is your campaign local or national:

*5.

Question - Required - What is the date(s) of your fundraiser (i.e. all of May, May 2-5, etc.)

*6.

Question - Required - What is your fundraising goal? We ask that all raised funds be sent to the Lupus Foundation of America by June 15, 2024.

*7.

Question - Required - What is your connection to lupus?

Question - Not Required - Organization Name, if applicable

(Maximum response 255 chars, approx. 5 rows of text)