Registration Information
First Name: *
Last Name: *
Cell:
Email Address: *
Fundraising Commitment
Goal:
$
Account Information
Custom URL:* Create your custom url to use for your personal fundraising page (This will also be your account username)
https://www.rayze.it/bina/
Personal Image:
Personal Message:
Additional Information optional
Additional Comments:

Only enter this field if you were told to do so by a staff member.


BINA is a 501(c)(3) non-profit organization. Tax ID# 56-2395556.
No goods or services were provided in exchange for this donation.
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