Exit this survey 2015 Holiday Drive Sign-Up Question Title * 1. Drive Coordinator Information: Name: Title: Email Address: Phone Number: Question Title * 2. Organization Information: Organization: * Name of CEO/Leader: * 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: * Number of Employees: * Question Title * 3. Type of Organization: Please Select One Type of Organization Company Independent/Small Business Membership Association Nonprofit Organization Government Agency School/Educational Institution Civic Group Faith-Based Organization Other Type of Organization Please Select One menu Question Title * 4. We will be collecting: Food Funds (for every $1 donated, the Food Bank can provide 4 meals!) Both Food & Funds Question Title * 5. Brief description of drive or event: Question Title * 6. We plan for our drive to take place during the following dates: Start Date: Date End Date: Date Question Title * 7. Drive Goal: Question Title * 8. Organization's Online Information: Website: Twitter Handle: Facebook Page: Question Title * 9. Additional Ways to Get Involved During the Holiday Season: We would like more information about sponsorship of Double Your Dollar Day or the end-of-year match We would like to make a corporate donation Done