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* 1. Group Name

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* 2. Group Type

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* 3. Location of Event

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* 4. Event Dates

Date
Date

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* 5. Contact Person at Event

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* 6. Contact Information

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

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* 8. Pick Up or Deliver (Please Choose One)

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

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* 12. Additional Requests

T