I want to be an Impact Player!*Which best describes you?IndividualGroupSchoolSmall BusinessLarge CorporationOtherContact Name* First Last Contact Email* Contact Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code How did you hear about the Tom Coughlin Jay Fund?*What is your connection to childhood cancer?Impact Program Idea:If you would like to discuss your idea, or if you need to brainstorm, feel free to call Cary Ann Moody at 904-685-6435.Proposed Event Date MM slash DD slash YYYY Fundraising Goal:*$0 - $2,500$2,501 - $10,000$10,000 +Unknown Δ
