Rescue Rig Event Request

1.

Contact information:

*

Name:

First Required	Last Required

*

Email: Required

*

Phone Number: Required

*2.

Question - Required - Your position:

*3.

Question - Required - Name of your organization:

4.

Question - Not Required - Your organization's website:

*5.

Question - Required - Is your organization a 501(c)(3)? Yes
No

*6.

Question - Required - Are you or is your organization an American Humane member? Yes
No

*7.

Question - Required - Type of event:

	Fundraiser
	Spay/Neuter Event
	Public Awareness
	Animal Emergency Services Training
	Community Event
	Other -- describe below

8.

Question - Not Required - If you selected Other above, please describe the event:

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

*9.

Question - Required - Date of event:

Month

Day

Year

*10.

Question - Required - Time of event:

*11.

Question - Required - Address of event:

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

12.

Question - Not Required - What date/time would you like us to set up?

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

13.

Question - Not Required - Expected attendance at your event:

*14.

Question - Required - Is there security for your event? Yes
No

*15.

Question - Required - How much space do you have for the Rig at your event (the rig is 82 feet long and will need appropriate space)?

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

*16.

Question - Required - Are you willing to take care of all reserved parking, permits, etc., for having an 82-ft.-long Rig? Yes
No

*17.

Question - Required - Have you contacted the local media? Yes
No

18.

Question - Not Required - Who is the media contact at your organization?

Rescue Rig Event Request

Thank You for Your Rescue Rig Event Request