2017 Texas Statewide School Outreach Collaborative Effort Because EVERY school in Texas should be aware of pipeline safety! Are you ready to accelerate school pipeline safety in Texas? Please fill out this form to pledge your $5,000 support for 2017 and help make Texas Schools a safer place when it comes to pipelines. * 1. Contact Information Name and Title Company Mailing Address City/Town State/Province ZIP/Postal Code Email Address Phone Number * 2. Billing Information (please skip if same as above) Name and Title Company Address City/Town State/Province ZIP/Postal Code Purchase Order Number (optional) Email Address Phone Number * 3. Please Select All Program Years You Wish to Sponsor 1st Program Year (Sept 1, 2016 - Aug 31, 2017) $5,000 2nd Program Year (Sept 1, 2017 - Aug 31, 2018) $5,000 * 4. Please tell us when you would like invoiced: Now Later (After January 2018) Other (please specify) * 5. For your convenience you may select who you prefer to be invoiced by for this program: Danielle Dawn Smalley Foundation Lone Star 811 Paradigm * 6. How, where, or from whom did you hear about this program? On behalf of Team Smalley and Texas schools everywhere, thank you for helping us make this program possible!You will receive an email soon explaining what to expect next! Click to Submit!