Thank you for choosing to fundraise for Good Samaritan. By completing the form below, we will have the information needed to create a fundraising page on Galantom.ro 

Here's an example page, so that you'll have an idea of what the page will look like. This page was created by Good Samaritan's founder Adrian Ciorna: 50 years, 50 scholarships, 50 homes 

 

First Name(*)
Please type your first name.

Last Name(*)
Please type your last name.

E-mail(*)
Invalid email address.

Phone(*)
Please type your phone number.

Address(*)
Please enter your address.

Address 2
Please enter your address.

Town/City(*)
Please enter your city/town.

State/County(*)
Please enter your state or county.

Postcode/Zip(*)
Please enter your postal/zip code.

Country(*)
Please select your country.

Details of your fundraising page

Below you will find various fields that need to be completed to help us create your fundraising page

Please select the project for which you would like to fundraise. To read more about the options available, click on the links below:

Project(*)
Please select the project for which you would like to fundraise

Please select the event through which you would like to fundraise.

Event(*)
Please select how you would like to fundraise

Please describe your fundraising idea.

Description
Invalid Input

Birthdate(*)
Please select your date.

Title for your fundraising page

Give your fundraiser a good title so your friends and family know what it is (e.g. Nigel's London Marathon Run, My 50th birthday fundraiser). Your fundraising page title can be anything you want.

Title(*)
Please enter what you would like as the title of your galantom page.

About your fundraiser

Tell everyone about your fundraiser and why it is so important to you. Make it personal and compelling.

Message(*)
Please enter the message that you would like to appear on your galantom page.

Photo for your page

Please select the photo that you would like to appear on your fundraising page. The photo should be in landscape format and have a minimum resolution of 560x360 px. Don't worry too much about dimensions though, as we'll resize/crop your photo if necessary.

Photo(*)
Please attach your photo

Fundraising target

Please fill in the amount that your would like to fundraise and in what currency. The amount which will appear on your page will be the equivalent in RON (Romanian lei).

Currency(*)
Please select the currency

Amount(*)
Please enter your fundraising target

Would you like to receive the latest news from Good Samaritan?(*)
Please enter whether you would like to receive emails from Good Samaritan.

Please enter the code without spaces between the letters in the box below(*)
Please enter the code without spaces between the letters in the box below
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