Donation Request

Thank you for your interest in Earth Treks for your fundraiser! Please fill out this donation request form and select the gym that is closest to you. Please give us a minimum of 4 weeks to process passes and mail them to you. If your request is less than 4 weeks out, we will not be able to process your donation request.
Date of Submission*
Date Format: MM slash DD slash YYYY
Gym*
Gym Location*
Gym Location*
Gym Location*
Requester's Name*
First Last
Requester's Email*
Enter Email Confirm Email
Name of Event*
Date of Event*
Date Format: MM slash DD slash YYYY
Address to Send Donation*
Street Address Address Line 2 City State ZIP Code
File Upload
Accepted file types: png, jpg, gif, pdf.
Additional Information:
Name
This field is for validation purposes and should be left unchanged.