State Farm Fundraiser

By completing the form below, you are granting Camp Brosend permission to share your information with State Farm agent Paul Watzlavik. You are also giving permission for State Farm to contact you with information on receiving a FREE insurance quote. There is no obligation for you to switch to State Farm, but in order for Camp Brosend to receive a $50 donation in your name, you must respond to the email you receive from State Farm and allow them to send you a quote. Once we receive confirmation of your participation from State Farm, we'll send you a $10 gift card of your choice. Thank you for participating in this simple fundraiser! (Deadline for participation is December 22nd.)

* Indicates required field

Name *

First

Last

Birthday (month/day/year) *

Email *

Phone (include area code) *

Address *

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City

State

Zip Code

Country

How did you hear about this fundraiser? (please list name of person if applicable) *

By submitting your information in this form, you acknowledge that Camp Brosend will send your information to State Farm and State Farm will contact you regarding an insurance quote. You also acknowledge that complete participation requires you to respond to State Farm's email allowing them to send you a quote and that you are under NO OBLIGATION to accept and switch to State Farm.

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