Host Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Business days:

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Contact Name *

First Name

Last Name

Contact Phone *

(###)

###

####

We are a *

New gift drive host

Returning gift drive host

Our gift drive will be *

Public - drive traffic and often additional sales to your business

Private - for internal employee and/or membership participants only

Gift collection options *

Onsite collection with a blue barrel (with virtual supplement)

Onsite collection without a blue barrel (with virtual supplement)

Virtual gift drive only via the online gift registries at Target, Best Buy and Amazon

Do you have a volunteer available to pick up a blue barrel?

Yes, we can help out with this!

No, we request assistance from the Gifts for Seniors volunteer team.

Do you have a volunteer available to periodically transport gifts to Gifts for Seniors? *

Yes, we would love to pitch in!

No, we request assistance from the Gifts for Seniors volunteer team.

Start Date *

The Gift Drive runs the first week in November through the first week in January. However, we offer flexibility to our partners. Please enter your preferred start date below.

MM

DD

YYYY

End Date *

The Gift Drive runs the first week in November through the first week in January. However, we offer flexibility to our partners. Please enter your preferred end date below.

MM

DD

YYYY

Will you be pursuing press coverage for your gift drive?

Yes

No