Register

If you are interested in building your own webpage for your loved one it is easy! If you prefer for the Society to build the page for you, we have an online application you can fill out. If you need a form mailed to you please contact Terri Klein at [email protected] or call 919.806.0101.

Use this form to register a new courage page to help raise donations for an individual

Your Name
First Last
Contact Email
Name of Recipient*
First Last
Syndrome*
Bio*
Write a couple sentences to introduce the person you are dedicating this courage page to
Goal*
dollar amount goal for fundraising
Story*
Main Background Photo
Upload a larger sized photo to be featured on the courage page. 2MB max file size.
Max. file size: 2 MB.
Profile Photo*
Upload a smaller sized portrait photo to be featured on the courage page. 2MB max file size.
Max. file size: 2 MB.
Gallery Photos
Upload photos to be featured on the courage page. 2MB max file size.
Drop files here or

Max. file size: 2 MB.
Password*
Enter Password Confirm Password

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