Individual/Organization Name
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Contact #1 Name
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First Name
Last Name
Contact #1 E-mail Address
*
Contact #2 Name
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First Name
Last Name
Contact #2 E-mail Address
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Individual/Organization Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Please provide a description of the type of same day services your agency will be providing the day of Project Connect:
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Would you allow our steering committee to put up a yard sign near your place of business (in Grand Island)?
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Yes
No
How many yard signs would you like and where should we put them up? (Can also be placed inside, if no yard).
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Will you need access to electrical outlets at the event?
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Yes
No
Will you need a private room to deliver your services?
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Yes
No
Will you need an internet connection?
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Yes
No
Will you be needing one or two tables?
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How many chairs will you need?
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Will you need any specific materials or supplies the day of the event?
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Will you need any additional accommodations? If so please explain.
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Actual service delivery at the event is from 10:00 am to 3:00 pm. Set up begins at 8:30 am. Please plan to provide services until the end.
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Project Connect, Fonner Park, Pinnacle Bank Expo center, and/or sponsors assume no responsibility for the safety of participants in this event. All participants recognize and agree by their participation that safety shall be their responsibility and hereby waive any right to seek recovery for an injury or damage which may be incurred, either to person or property as a result of or in connection with, this event or participation therein. I also give permission for my name and/or picture to appear in any media, including but not limited to, brochures, posters, newsletters, flyers, and broadcast media.
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Each booth will be provided with at least one 6' or one 8' table. If you need specific equipment or additional space, please indicate that below. Please be specific as possible in your request. The Project Connect committee will review your request and try to accommodate this request.
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Signature
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