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Celebrating Long Lives 2022 Fundraiser Prize

Questions marked with a * are required

Thank you for participating in CLL Society's inaugural Celebrating Long Lives 5K Walk/Run to support those touched by CLL/SLL! As a fundraiser for the event, you get to select one CLL Society swag item for your efforts. Please complete this form to select which item you would like to receive.

Please be aware that you may only select one item at or below the amount you raised. CLL Society will be confirming all fundraising levels before sending items. If you need to check the amount you raised, please visit: https://cllsociety.app.neoncrm.com/publicFundraiserList.jsp?campaignId=32& and find yourself among the list of fundraisers.

If you have any questions, please contact Nicole Kamphuis, Communications Specialist, at nkamphuis@cllsociety.org.

Full Name (First and Last name)

Email Address

Please provide the address you would like your fundraising prize sent to:

Address Line 1

Address Line 2

City

Zipcode

Country

Please choose your fundraising prize. You may select one prize at or below the fundraising amount you reached:

For raising at least $100: Sunglasses

For raising at least $250: Water Bottle

For raising at least $500: Reusable Bag

For raising at least $1,000: Hat

For raising at least $5,000: Sweater

I do not want to receive an item