Fundraiser Registration

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MAKE A REAL IMPACT WITH WVI

Fill out this form to be part of the change

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Personal InformationVerification and Security Information

Personal Information

Profile Photo*

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(JPG/PNG, min. 600×600px, max 2MB)

Your Full Name*

Phone Number*

Your Email*

Your Date of Birth*

DD/MM/YYYY

Gender*

Password*

Confirm Password*

Parental/Guardian Consent

Parent/Guardian Name

Child Name

As a parent/guardian, I hereby consent to my child's participation in Wahana Visi Indonesia's volunteering activities in accordance with the applicable terms and conditions.