Survey - Event Submission Form - Second Harvest Heartland

*1.

Question - Required - By selecting yes, you agree that you have read and understand our event guidelines.

Contact Information

2.

Please provide your contact information.


*	First Name: Required
*	Last Name: Required
*	Email: Required
*	Street 1: Required
	Street 2:
*	City: Required
*	State / Province: Required
*	ZIP / Postal Code: Required
*	Phone Number: Required
	Employer:
	Yes, I would like to receive e-mail from Second Harvest Heartland
	Yes, I would like to receive postal mail from Second Harvest Heartland
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Event/Promotion Information

*3.

Question - Required - Event Title:

*4.

Question - Required - Date of event:

Month

Day

Year

*5.

Question - Required - What time is your event?

*6.

Question - Required - Location name and address:

(Maximum response 255 chars, approx. 5 rows of text)

7.

Question - Not Required - Special directions or instructions:

(Maximum response 255 chars, approx. 5 rows of text)

*8.

Question - Required - Please give a brief description of your event:

(Maximum response 255 chars, approx. 5 rows of text)

*9.

Question - Required - Are there any other beneficiaries of this event or promotion?

(Maximum response 255 chars, approx. 5 rows of text)

10.

Question - Not Required - If yes, name other organization(s):

*11.

Question - Required - How is this event being promoted by your organization?

(Maximum response 255 chars, approx. 5 rows of text)

*12.

Question - Required - Who is the audience for this event and how many attendees do you expect?

*13.

Question - Required - Would you like to include SHH literature at your event?

14.

Question - Not Required - If so, how many?

15.

Question - Not Required - What additional support* would you like from SHH?

(Maximum response 255 chars, approx. 5 rows of text)

Financial Information

Estimate revenue from your event (your group will not be held liable for the amounts listed). The following is a planning tool to help us understand the scope of your event.

16.

Question - Not Required - Is there anything else you'd like us to know about your upcoming event?

(Maximum response 255 chars, approx. 5 rows of text)

*17.

Question - Required - Estimate gross proceeds:

*18.

Question - Required - Estimate expenses:

*19.

Question - Required - Estimate donation:

*20.

Question - Required - Expected date of donation:

Note: all donations must be made within 45 days of completion of the event or promotion.

*We appreciate the event you are holding to benefit SHH. We will consider your requests for additional support and will follow up with you with a confirmation of our support.

Event Submission Form

Contact Information

Event/Promotion Information

Financial Information

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