2016 Halloween Safe Kids Night Registration

Welcome to the 2016 Halloween Safe Kids Night Partner Registration

Thank you for taking the time to register your organization for participation in the 13th Annual Halloween Safe Kids Night, hosted by Manatee Crimestoppers. This year's event will occur on Monday October 31st, 2016 at the DeSoto Square Mall (inside the former Boater's World) in Bradenton from 5:30p - 8:30p. If your agency, company, church or business is interested in hosting a booth or participating in some way, please register by completing the questionaire below. First priority will be given to past participants, but we do anticipate extra spaces this year due to the change in Venue. If you are aware of other interested participants or sponsors, please pass on the link to this registration and encourage them to complete the form. Once you complete the questions, your information will automatically upload into our database. Thanks

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* 1. Please tell us the name of your organization / agency.

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* 2. Please provide us with the contact information of the person from your organization who will be responsible for your participation:

Name: *

Company: *

Address: *

Address 2:

City/Town: *

State: *

ZIP: *

Phone Number: *

Email Address: *

Mobile Number:

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* 3. Please categorize the type of organization you are:

Youth Service Organization/ Club which provides volunteers for service hours

Local Government Agency

State or Federal Agency

Non-Profit Organization / Civic / Church / School

Coalition of multiple agencies

Private Company or Business

Other

If Other (please explain)

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* 4. Please share with us your desired level of participation (check all that apply)

We are interested in reviewing a package with sponsorship opportunities

We require a standard 10'x10' inside booth

We require 1 conference table + 2 chairs

We require access to power

We request additional space (granted based on availability)

We would like outdoor space to display public safety vehicles / equipment

We have additional volunteers who would like to assist with the event staffing

Other

If you have any other needs (please specify)

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* 5. We are aware of the organizational meeting / partner check-in at the DeSoto Square Mall Food Court in Bradenton on Thursday 10/27/2016. You may check in anytime between 4:00pm - 6:00pm. You must have a representative check in:

YES - we will have a representative present on 10/27

YES - count us in as a partner this year, but we are unable to send a rep to check in. We will have someone check in at the DeSoto Square Mall "Boaters World" on Friday between 1p - 4p.

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* 6. We acknowledge that hosting a booth is free, but we are expected to decorate and staff the booth for the full 3 hours of the event. Additionally, we will bring enough candy / treats to distribute to at least 2500 people.

YES

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* 7. We acknowledge that our booth must be completely decorated / set up / functional no later than 4:30pm on 10/31/2016.

YES

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* 8. Please provide us with any additional information, concerns or considerations you would like to communicate to Manatee CrimeStoppers, the event Sponsor: