Survey - Food and Fund Drive Registration - Northern Illinois Food Bank

*1.

Question - Required - What type of drive are you holding?

Food Drive

Fund Drive

Food and Fund Drive

*2.

Question - Required - Enter the approximate start date of the food and/or fund drive:

Month

Day

Year

*3.

Question - Required - Enter the approximate end date of the food and/or fund drive:

Month

Day

Year

*4.

Question - Required - Is this food and/or fund drive associated with a company or organization?

Yes

No

5.

Question - Not Required - Company/Organization Name:

6.

Question - Not Required - Number of employees/members in the company/organization:

1-50

51-100

100+

N/A

7.

Contact information for drive coordinator:

*

Name:

Title	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 Northern Illinois Food Bank

*8.

Question - Required - Please list the name of the location(s) where you intend to collect food donations on behalf of Northern Illinois Food Bank. Include the dates and times you or a representative from your organization will be present for collections.

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

9.

Question - Not Required - The Food Bank is able to accommodate food donation pick-ups of 1,000+ lbs. (30 copy paper boxes) on Wednesdays. With at least a 7 day notice, choose your preferred Wednesday pick-up date.

Month

Day

Year

*10.

Question - Required - I would like to pick up food drive collection boxes for my drive. (Boxes are 19.5" square and 34" tall)

Yes

No

*11.

Question - Required - I am interested in using food drive posters to help advertise my drive.

Yes

No

12.

Question - Not Required - Which Northern Illinois Food Bank location would you like to visit to pick up your boxes/posters?

West Suburban Center (273 Dearborn Court, Geneva, IL 60134)

North Suburban Center (440 Keller Drive, Park City, IL 60085)

Northwest Center (765 Research Parkway, IL 61109)

*13.

Question - Required - Northern Illinois Food Bank's approval of this registration form does not grant permission to the applicant to solicit food or fund donations on behalf of the Food Bank at or outside of any of our retail or other partners.

I agree

*14.

Question - Required - It is prohibited for anyone, other than Northern Illinois Food Bank employees, to create and issue any type of receipt (handwritten or otherwise) to the public without written consent from Northern Illinois Food Bank.

I agree

*15.

Question - Required - All uses of the Northern Illinois Food Bank logo must be approved by the Food Bank. We request five full business days to review and approve all collateral on which the Northern Illinois Food Bank logo and/or name appears.

I agree

*16.

Question - Required - I'm interested in learning more about meeting space opportunities at the food bank's West Suburban Center in Geneva and/or the Northwest Center in Rockford.

	Yes, I'm interested to learn more about opportunities in Geneva.
	Yes, i'm interested to learn more about opportunities in Rockford.
	No

*17.

Question - Required - I'd like to learn more about sponsorship opportunities for Northern Illinois Food Bank's signature events.

Yes

No

18.

Question - Not Required - Other Comments:

Help Solve Hunger for Our Neighbors in Need

Food and Fund Drive Registration