GSA Application - Community Event

Please answer every question. If the questions is not applicable to your event, please respond n/a.

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* 1. Please provide your contact information below.

Contact Name:

Event Name:

Email:

Phone:

Fax:

Address:

City, Zip:

County:

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* 2. Event Date (s)

	Month	Starting Date	Month	Ending Date
Dates	Dates Month menu	Dates Starting Date menu	Dates Month menu	Dates Ending Date menu

Additional Comments

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* 3. Space requirements - check all that apply

Size (80' x 100')

Paved

Accessible to a 70' trailer

Additional Comments

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* 4. Associated fees, if applicable

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* 5. Please list past attendence, if applicable, and expected attendance

Past Attendance:

Expected Attendance:

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* 6. Are you able to provide 5 volunteers for the duration of the event?

Yes

No

Not sure at this time

Additional Comments

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* 7. Has Kohl's Cares: The Great Safety Adventure exhibited at your event in the past?

Yes

No

Additional Comments

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* 8. Any additional comments. Please note that the filing of this application does not guarantee that Kohl's Cares: The Great Safety Adventure will be able to schedule a stop at your event.