MEMBER REQUEST FOR OUTREACH EVENTS

*please allow at least 3 weeks for shipping of items. Any questions, please contact Mindy Soranno ([email protected]). All requests must use this form.

REQUESTOR NAME(Required)

First Name Last Name

REQUESTOR EMAIL(Required)

[email protected]

REQUESTOR PHONE(Required)

Please enter a valid phone number.

Your Facility(Required)

MAILING ADDRESS FOR ITEMS TO BE SHIPPED: CANNOT BE A P.O. BOX(Required)

Street Address Address Line 2 City State ZIP Code

DATE OF EVENT:

PLEASE GIVE BRIEF DESCRIPTION OF THE EVENT; AGE GROUP OF ATTENDEES

ITEMS YOU ARE REQUESTING:

Booth

TABLE COVER

COLORING BOOKS

ACTIVITY BOOKS

BALSA WOODS AIRPLANES

OTHER

HOW MANY COLORING BOOKS?

HOW MANY ACTIVITY BOOKS?

HOW MANY BALSA WOOD AIRPLANES?

IS THERE ANOTHER ITEM NOT LISTED THAT YOU NEED? IF SO, HOW MANY?

I _________________________ will return booth and table cover to the NATCA National Office within 3 days of the event.(Required)

First Last

I will use the NATCA National Office UPS account and will insure the shipment in the amount of $______.(Required)

Signature(Required)

Date(Required)