Username
First Name
Last Name
Preferred name
Pronouns: Self-Described
Email
Twitter handle
Discord ID (username#number)
Twitch Username
YouTube channel name
Preferred streaming platform YouTube Twitter Discord
How did you hear about us? Social Media Word of Mouth Twitch Tiltify amfAR Event amfAR Staff Other
Would you like to receive future amfAR news and updates via email? yesno
Are you fundraising for a specific amfAR Campaign? No campaign World AIDS Day Pride Month Women's History Month
Would you like to work 1:1 with amfAR staff to help you plan your fundraiser event? yes no
What date(s) and times are you planning your event(s)?
What time zone will your event take place in? Eastern Central Mountain Pacific Other (please specify)
What is your fundraising goal?
Are you joining as part of a stream team? yes no
If yes, provide team name
Are you interested in hearing from amfAR about future fundraising events? yes no
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