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Change Bandit Sign-Up Form

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CHANGE BANDIT CONTACT INFORMATION

Dr.   Mr.   Mrs.   Ms.  
Male   Female  
Residence   Business  

CHANGE BANDIT PARTICIPATION


Individual/Family  
School -School District Name  
Business/Organization (less than 100 employees)  
Business/Organization (more than 100 employees  
Akron Children's Hospital Department - Department Name  
Previous Change Bandit
Radio
Community event
Social Media (Facebook, Twitter, etc.)
Direct mail
Papa John's box topper
Other (please fill in)

Do you have a story to share with Radiothon listeners? Please use the following field to share your Akron Children's Hospital story. Some stories might be selected and possibly edited to be read on the air during Radiothon. By supplying a story, you give Akron Children's Hospital permission to use your personal name or business name.

I agree to abide by any state laws governing fundraising and all Akron Children's Hospital guidelines.