Thank you for your interest in hosting a house party for Planned Parenthood Columbia Willamette (PPCW)! Please fill out this simple form and one of our staff members will be in contact with you shortly.

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* 1. First & Last Name

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* 2. Phone number

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* 3. E-mail address

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* 4. Address (including city, st. and zip)

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* 5. I am interested in: 

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* 6. If you plan to ask for donations at your event, what percentage of proceeds will go to PPCW? (We require at least 50% proceeds donated to PPCW if you'd like us to help promote, use PPCW swag, or have a staff member/volunteer present.)

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* 7. How would you like us to follow up with you? 

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* 8. Notes/comments/questions? 

Questions? Need more info? Contact Ariel at ariel.borgendale@ppcw.org or 503-775-4931 x.3256

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