Event Information Form
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EVENT DETAILS
Event Name:
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Event Start Date:
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Event End Date:
*
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Event Start Time:
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Event End Time:
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# of Refresh Vehicles Requested:
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Primary Contact First Name:
*
Primary Contact Last Name:
*
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Primary Contact Title:
Primary Contact Email:
*
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Primary Contact Phone:
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Event # of Attendees (est):
Event # of Attendees to use Van (est):
Event Type (choose one):
Indoor Event
Indoor Event
Outdoor Event
Public Event
Private Event
Disability Related Event
Concert
Conference
Street Fair/Market
State Fair/Co. Fair
Sporting Event
Other
Event Web Page:
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Event Address:
Address Line 1
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Details on where the Van will be parked (See Vehicle Set up Specific):
Arrival / Load-in and Departure Details and Times:
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Upload Sitemap:
Click or drag a file to this area to upload.
Having trouble with attachments? Hold of for now and complete/submit the rest of this form and we’ll make arrangements to obtain from you another way.
Is there a 20 amp electrical outlet?
Yes
No
Electrical Outlet Comments:
Setup Location (Images):
Click or drag a file to this area to upload.
Details and Directions for Parking Vehicle:
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Are there water hookups?
Yes
No
Water Hookup Comments:
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Are there sewer hookups?
Yes
No
Sewer Hookup Comments:
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Is there a dumpster near for trash?
Yes
No
Dumpster Comments:
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Will Refresh need a parking pass?
Yes
No
Parking Pass Comments:
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Is there an entry fee and tickets provided to our staff?
Yes
No
Entry Fee and Tickets Comments:
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Venue Security Name:
Security Contact Phone:
Upload: Incident Action Plan (IAP) or Event Action Plan (EAP)
Click or drag a file to this area to upload.
Having trouble with attachments? Hold of for now and complete/submit the rest of this form and we’ll make arrangements to obtain from you another way.
MARKETING
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Marketing Contact Name:
Marketing Contact Email:
Marketing Contact Phone:
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Can we post signs on site?
Yes
No
Signage Comments:
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Can we collaborate on social media posts?
Yes
No
Social Media Comments:
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Is it possible to include Refresh on event map?
Yes
No
Event Map Comments:
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Are there other groups we should collaborate with to help promote?
Yes
No
Who?
BILLING INFORMATION
Company/Organization:
PO Number:
Billing Contact Name:
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Billing Address:
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Certificate of Insurance (COI) should be directed to:
Method of Payment:
Check
Check
Credit Card (includes additional 3% fee)
ACH
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COI Address:
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
OTHER
Is there specific data you would like us to collect throughout the event?
Any Hotel Recommendations for Our Staff?
Submit