Healtheries Dan Carter School Promotion 2015 Please ensure you have approval (if required) before completing this form. Question Title * 1. School Name: Question Title * 2. Does your school want to participate in the 2015 Healtheries Dan Carter school promotion? Yes No Question Title * 3. Do you agree to display the posters provided around your school for the month of March? Yes No If NO, please specify why: Question Title * 4. Do you agree to give the flyers provided to the children to take home to their parents by March 6th? Yes No If NO, please specify why: Question Title * 5. Your contact details (for communications around this promotion): Name: Phone: Email: Question Title * 6. How many children are enrolled at your school? Question Title * 7. If your school is eligible, do you want to receive free sample packets of Healtheries Potato Curls to give out to all the children at your school? (The first 100 responding schools are eligible.) Yes No Other (please specify) Question Title * 8. Please provide the best POSTAL address for your school: PO Box/Private Bag Number: Street Number & Name: Suburb: City: Postcode: Question Title * 9. Please provide the best COURIER address for your school: Street Number & Name: Suburb: City: School opening hours: Any special delivery instructions: Question Title * 10. Any other questions/comments: Done