Guide Dog Foundation or America's VetDogs?  AVD BOTH GDF  

Name of Organization 

Address of Organization

Address Line1      

Address Line2     

City                       

State                     Alabama Alaska Alberta Arizona Arkansas Armed Forces Armed Forces America Armed Forces Pacific British Columbia California Canal Zone Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Labrador Lousiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland and Labrador North Carolina North Dakota Northwest Territories Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon   

Zip                        

Website               

Event Name   

Date of Event  

Time of Event  

Event Address Line1  

Event Address Line2 

Event City  

Event State  Alabama Alaska Alberta Arizona Arkansas Armed Forces Armed Forces America Armed Forces Pacific British Columbia California Canal Zone Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Labrador Lousiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland and Labrador North Carolina North Dakota Northwest Territories Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon  

Event Zip  

Duration   

At what time is the representative expected to attend and speak?  

Is meal and/or transportation provided for the speaker?  

What is the dress code?  

Audience  Adults Children Both  

If children, age range: 

# Adults Attending?   
# Children Attending?  

Type of Opportunity  Information Table Mingle and Chat Speaking Opportunity  

Is this a Fundraising Event?  Does Not Apply No Yes

Will your group be presenting a monetary donation?  Yes No  

Will there be a check presentation?  No Yes  

Have you or your group made a contribution in the past to either the Guide Dog Foundation or America's VetDogs?  No Yes  

Will your group be presenting items to donate?  No Yes  

Is your event In/Outdoor?  Indoor Outdoor  

Will a table and chairs be provided?  Yes No  

Are you requesting materials i.e. literature, banners, etc. to be provided for attendees?  No Yes  

Is this a photo opportunity?  No Yes  

Parking Availability: Onsite Parking Available Paid Parking Only Street Parking Only

Please list details or additional information: 

Is this an opportunity to recruit volunteers?  No Yes  

Comments: 

Main Contact Info:

First Name   

Last Name  

Primary Phone  

Secondary Phone 

Email Address  

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