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
*
First Name
Last Name
Contact #2 E-mail Address
*
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 provide during Project Connect.
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Would your organization like a Project Connect yard sign displayed at your place of business? (Grand Island area only)
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Yes
No
How many yard signs?
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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/privacy panels to deliver your services?
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Yes
No
Who would you like to be stationed next to?
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Will you need an internet connection?
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Yes
No
How many tables will you need for your booth area?
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How many chairs will you need?
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Would you be willing to host a hygiene item collection box at your location prior to the event?
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Yes
No
Maybe, please send more info.
Will you need any additional accommodations? If so, please explain.
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Service delivery is from 10:00 am to 3:00 pm. Set-up begins at 8:30 am. Please plan to stay until the end of the event.
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Liability and media release: Project Connect, Fonner Park, Pinnacle Bank Expo Center, and event sponsors assume no responsibility for the safety of participants. By participating, you accept responsibility for your own safety and waive the right to seek recovery for injury or damage in connection with this event. You also grant permission for your name and/or photo to appear in media such as brochures, posters, social media, and other promotional materials.
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Booth space: Each booth will be provided with at least one 6' or 8' table. If you need special equipment or additional space, please describe it below. We will do our best to accommodate.
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Signature
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