Register

First Name *

Last Name *

Email Address *

Password *

Phone *

Please do not list a PO Box

State

Country

Organisation Name

I'm holding my fundraiser on *

This date doesn't need to be set in stone; you can change it any time.

I am part of a

Pink Stumps Day Kit (requires a minimum fundraising commitment )
No Kit

In 100 words or less tell us why you should win the Ultimate Pink Test Experience*

I accept the terms and conditions of registering my Pink Stumps Day