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1. Group Name (Required.)

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2. Group Type (Required.)

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3. Location of Event (Required.)

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4. Event Dates (Required.)

Date
Date

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5. Contact Person at Event (Required.)

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6. Contact Information (Required.)

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7. Number of Bags Needed (Number of Attendees)
*Minimum of 10 Bags (Required.)

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8. Pick Up or Deliver (Please Choose One. Pickup and Delivery Monday-Friday Only) (Required.)

Date
Date

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9. Deliver to
(Deliveries will only be made in Deadwood City Limits, Welcome Bags will Not be Mailed)

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10. Would you like a referral for

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11. Requested By (Required.)

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12. Additional Requests

T