Earth Dinner Support Request Form

1. Organization Information:

Type of Organization
Restaurant School Non-profit Individual

Name of Organization:

Address of Organization:

Shipping Address (if different than organization address):

Event Contact Person:

Telephone:

Email:

Title/Position:

Fax:

Web Site:

Date(s) of Event(s):

Location of Event (leave blank if unknown):

Purpose of Event (check all that apply):

Educational
Fundraiser
Social Activity
Other (please explain):

How does your Earth Dinner plan align with our Support Guidelines?

Expected audience & number of attendees:

Has Organic Valley donated to your organization in the past? Yes  No

Please describe past donations:

Cash Donation Request:

Product Donation:

Organic Valley farmer-member to speak at event (limited to events with 100+ attendees)

4. Organic Valley Recognition
(Your organization must choose at least two of the following, in addition to the required items)

Spoken acknowledgement at event REQUIRED
Media acknowledgement (check all that apply)
      Radio
      TV
      Newspaper
Organic Valley downloadable materials and/or literature distributed at event
Acknowledgement in your organization's Brochures / Programs