Thank you for your interest in Women Against Abuse (WAA) and our mission to end domestic violence in our community.Women Against Abuse is more than happy to provide domestic violence resources (e.g. handouts, hotline cards) and other organizational materials (e.g. brochures) for community events! Please note that due to limited staff capacity, we cannot guarantee that a representative will be available to attend community events.Please allow three weeks for a response to your request. We are unable to accommodate last minute requests. Question Title * 1. Please tell us about yourself and your organization! Name: * Company: Address: * Address 2: City/Town: * State: * -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: * Country: Email Address: * Phone Number: Question Title * 2. What type of event is this? Please select the most relevant choice. Health Fair Fundraiser Community Awareness Event Workplace or United Way Fair Question Title * 3. Is this a new/ first time event? Yes No Question Title * 4. Please tell us about the event. Include as much detail as possible! Question Title * 5. Please fill in as much information as possible about the event. Complete answers greatly assist us in responding to your request. We understand that events may be at various stages of planning. Please write in "TBD" if the response is to be determined. Event Title Location Indoor or Outdoor event? Date Start Time End Time Day of Contact Target Audience (e.g. college students, health professionals, public) Expected Audience Size Admission Fee (N/A if not applicable) Event website Will a table be provided? Question Title * 6. How can we assist you in preparing for this event? Provide organization materials Provide domestic violence resources Requesting a Women Against Abuse Representative (please note due to limited staff capacity, we cannot guarantee a representative will be available) Other (please specify) Question Title * 7. How did you find out about WAA? Done
