InterAct Event Registration Form

Event Description

Date of Event

Time of Event

Event Location - Street Address
City

State

Zip Code

Purpose of Event
Community Engagement and OutreachDonation DriveFundraising

Event Frequency
One TimeMonthlyQuarterlyIndefinite

Event Website

Event Facebook

Event Twitter

Contact Telephone

Use of InterAct Logo?
YesNo

How Will Logo Be Used?

Request for InterAct Materials
InterAct MaterialsDomestic Violence MaterialsSexual Assault Materials
Additional Materials (please list)

Are You Reuqesting An InterAct Booth At Event?
YesNo

Are You Requesting A Representative from InterAct At Event?
YesNo

Time Speaker Needed

I have read and understood the above guidelines and registration and ensure InterAct's name will be properly used, funds will be handled and accounted for in a responsible manner, fundraising will be conducted in a method that is consistent with the public image of InterAct and that all those associated with the event or promotion will act in accordance with all municipal and federal laws. I understand that at anytime InterAct can withdraw its permission if it feels its reputation is at risk or any other liability or challenge arises.

Signature

Date