Survey - Event Submission Form - OneLegacy Community Event Submission Form

1.

Requestor Information:

*

Name:

First Required	Last Required

*

Email: Required

*

Street 1: Required

*

City/State/ZIP:

City Required	State Required	ZIP Required

*

Phone Number: Required

Yes, I would like to receive e-mail from OneLegacy Foundation

Yes, I would like to receive postal mail from OneLegacy Foundation

Keep me logged in. What's this?

*2.

Question - Required - Event Name or Title:

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

*3.

Question - Required - Event Date:

Month

Day

Year

*4.

Question - Required - Time Frame of Event:

*5.

Question - Required - Event Street Address

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

*6.

Question - Required - Event Zip Code

*7.

Question - Required - Please include parking instructions:

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

8.

Question - Not Required - Event Website (if applicable):

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

*9.

Question - Required - Total Event Cost:

*10.

Question - Required - Will OneLegacy need to provide a Certificate of Insurance?

*11.

Question - Required - Expected Number of Attendees:

1-150

151-200

201-500

501-999

Over 1,000

*12.

Question - Required - eRegistration Goal (Number of people you would like to strive to register on the Donate Life California Donor Registry)

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

*13.

Question - Required - Brief description of event:

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

*14.

Question - Required - Is the event associated with any of the following organizations:

	DMV Office
	Hospital
	Medical Clinic
	High School
	OneLegacy Community Partner
	OneLegacy Employee
	Not associated with any of the above

*15.

Question - Required - Has OneLegacy participated in the event in the past:

*16.

Question - Required - Please let us know why you feel as though OneLegacy should participate in this event:

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

*17.

Question - Required - Will OneLegacy/Donate Life promotional items be needed for the event?

*18.

Question - Required - Will the support of OneLegacy Staff or Ambassadors be needed for this event:

*19.

Question - Required - Will OneLegacy EZ-Up/Pop-up tent be needed for the event?

*20.

Question - Required - If support is needed please describe what is required (If no support required please write N/A):

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

*21.

Question - Required - Will OneLegacy need to provide table and chairs for event?

*22.

Question - Required - I have read the Event Submission Form Guidelines and have filled out the form to the best of my knowledge. If the Event Submission Form is approved I agree to follow the guidelines and any additional terms agreed to with OneLegacy in connection with this event.