*
Question - Required -
Name of your event:
*
Nature of engagement:
(Select one of the available choices or enter a different value.)
Question - Required - Nature of engagement: Click this to indicate that you will select an existing value. Tab to next input."
Nature of engagement:
Please select response
Speaking engagement
Staff a booth
Accept a check
Nature of engagement: Click this to indicate that you will enter a new value. Tab to next input."
Nature of engagement: Provide your answer here
*
Question - Required -
Date of event:
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
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11
12
13
14
15
16
17
18
19
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21
22
23
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25
26
27
28
29
30
31
Year
Year
2036
2035
2034
2033
2032
2031
2030
2029
2028
2027
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
*
Question - Required -
What time should the SHH representative arrive?
*
Question - Required -
Location name and address:
(Maximum response 255 chars, approx. 5 rows of text)
*
Question - Required -
Will someone greet/escort staff once they arrive? Who?
Question - Not Required -
Special directions or instructions?
(Maximum response 255 chars, approx. 5 rows of text)
*
Question - Required -
Size of group:
0-20
21-50
51-100
100+
*
Question - Required -
Level of formality:
Informal (staffing a table, volunteer fair, etc.)
Semi-formal (staff presentation, check presentation, etc.)
Formal (attendance at a meeting, executive-level presentations, etc.)
Question - Not Required -
Department and/or division to be addressed:
Question - Not Required -
Are there key stakeholders at your organization who the speaker should be prepared to meet? If so, who (name/title)?
(Maximum response 255 chars, approx. 5 rows of text)
*
Question - Required -
Length of presentation/engagement:
*
Question - Required -
Technology capabilities at venue:
(Maximum response 255 chars, approx. 5 rows of text)
Question - Not Required -
If you need the SHH representative to hand out materials, how many would you like us to provide?
*
Question - Required -
Do you need a speaker/ambassador bio?
Please select response
Yes
No
*
Question - Required -
Why do you plan to include information about Second Harvest Heartland at your upcoming event and what message would you like us to share?
(Maximum response 255 chars, approx. 5 rows of text)
Question - Not Required -
Has your organization partnered with Second Harvest Heartland in the past? If so, in what capacity?
(Maximum response 255 chars, approx. 5 rows of text)
Please provide your contact information so we can get back to you.
*
Title:
Mr.
Ms.
Mrs.
Miss
Dr.
Required
*
First Name: Required
*
Last Name: Required
*
Email: Required
*
Street 1: Required
*
Street 2: Required
*
City: Required
*
State / Province: Required
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
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NE
NH
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NY
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OK
OR
PA
RI
SC
SD
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UT
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VT
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WI
WV
WY
AS
FM
GU
MH
MP
PR
PW
VI
AA
AE
AP
AB
BC
MB
NB
NL
NS
NT
NU
ON
PE
QC
SK
YT
None
Required
*
ZIP / Postal Code: Required
*
Phone Number: Required
*
Employer: Required
Occupation:
Accounting
Administrative, Support, and Clerical
Advertising
Aerospace and Defense
Agriculture, Forestry, and Fishing
Architecture
Arts and Entertainment
Aviation and Airlines
Banking and Financial Services
Clergy
Construction and Landscaping
Consulting
Education and Training
Engineering
Environment
Executive/Management
Facilities, Maintenance, and Repair
Fire, Law Enforcement, and Security
Government
Healthcare
Homemaking
Hotel, Gaming, Leisure, and Travel
Human Resources
Information Technology (IT)
Insurance
Legal and Paralegal
Manufacturing
Marketing
Media
Military
Nonprofit
Personal Care and Service
Photography
Property Management
Psychology
Publishing
Real Estate, Rental, and Leasing
Restaurant and Food Services
Retail/Wholesale
Sales
Science and Biotechnology
Skilled Work and Trades
Social Work
Stock Broker/Investment Advisor
Student
Telecommunications
Transportation and Warehousing
Required
Yes, I would like to receive e-mail from Second Harvest Heartland
Yes, I would like to receive postal mail from Second Harvest Heartland
Question - Not Required -
Anything else you'd like us to know about your upcoming event?
(Maximum response 255 chars, approx. 5 rows of text)