Register here for your selfie frames!

Please fill out the #HDFreeInTheCity registration form ONLY if you wish to receive selfie frames for your campaign. A HelpCureHD staff will contact you within 72 hours of your submission.

Please Note: There is NO donation required to start your fundraiser! If you wish for HelpCureHD to provide you with Selfie Frames, a $100 donation is required for a set of 3. Thank you!

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

How did you hear about us?

Location of fundraiser?

Fundraising goal?

Have you reviewed the HelpCureHD Toolkit?

if no, please read the guide before proceeding