Create Campaign Form Step 1 of 2 50% First name*Last name*Email address* Phone number*Mailing address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Preferred method of contact*EmailPhoneBest time to call you?*Morning (8am-12pm)Afternoon (12pm - 5pm)Evening (5p - 9pm)How did you hear about The LifePump?How do you plan to fundraise (check as many as necessary): At work At church At school Through events Through friends and family Other If you choose "Other" Title of your campaign* This will appear as title of your campaign page.Short bio about you and/or your organization*This short bio will appear at the right side of your campaign page as "Fundraiser Info". What compels you to fundraise for a village water pump?*This will appear on your campaign page as your "appeal" to your friends and family, why they should join you in providing clean water for a village.Choose Your Campaign*ProjectPilotWhere It's Needed MostYou can learn more about these options on our fundraising pageCampaign Goal*$10,000.00$5,000.00$2,500.00$1,000.00$500.00Your website Twitter Facebook Start Date* When would you like your campaign to start?Upload or Choose an Image*Upload Campaign ImageChoose an ImageFeatured campaign imageThis will be placed on the top featured image of your campaign. Choose an ImageAdditional ImageAccepted file types: jpg, gif, png.It can be you, your organization/company. Please upload horizontal pictures only.