Please enable JavaScript in your browser to complete this form.Name *FirstLastOrganization NameAddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone NumberEmail *I Want to Learn More About: *Hosting a Training in My HomeHosting a Training in My ChurchHosting a Training for My GroupBecoming a 10.18 Trainer in My CommunityHost a Heart Day or Holiday CampaignRequesting a 10.18 SpeakerDonate Gifts-N-Kind ItemsBecome a SponsorOtherPlease select all that apply.Other Info Desired: *Host Training Request Details:I would Like to Host the Training *Within 30 daysWithin 3 MonthsWithin 6 MonthsSometime this YearOtherOther Time Desired *Request a Specific TrainerTraining Desired *Watchful Eye Safety & PreventionMandated ReporterAdvocacyFoster Care & Adopt Info MeetingOtherSelect All that ApplyOther Training Desired *Number of Trainees Attending Selected Value: 0 Estimated count if availableTrainer Information Request:Train-the-Trainer Course DesiredWatchful Eye Safety & PreventionMandated ReporterAdvocacyFoster Care & Adopt Info MeetingOtherSelect All that ApplyOther Train-the-Trainer Desired *Nearest Major City/Metro Area *Host a Heart Day or Holiday Campaign Request:Campaign Desired *- Select One -Heart Day - Awareness & FundraiserHeart Holiday Campaign - Heartfelt Gifts for Traumatized ChildrenCustom Plan Arranged with 10.18Custom Heart Day/Campaign Plan Desired: *Please provide as much detail as the type of day/campaign you are desiring for your organization or group. If you have a specific goal in mind please let us know!Our Organization Would Like to Provide: *Have a Christmas Heart Tree at Our Location for Child SponsorshipsCollect Donated New Coats & Winter GearCollect Donated New Stuffed AnimalsCollect Donated New Games, Puzzles & CraftsCollect Donated New or Homemade BlanketsCollect Donated Unopened Ginger Bread House or Cookie KitsCollect Donated Christmas Cards to the KidsCollect Donated Tickets, Passes & Gift Cards to ActivitiesCollect Donated Gift Cards to Retail & Restaurants ($5 to $20)Make a Monetary DonationUndecided...Cordinate with 10.18 for Greatest NeedPlease select your top 3 choices. 10.18 Guest Speaker Request:Date / Time Needed *DateTimeName & Location of Venue *Please describe your venue, event, meeting or session you are requesting a guest speaker for.Length Requested *- Select One -15 Minutes30 Minutes1 Hour3 HoursHalf Day EventFull Day EventMulti Day EventPlease provide the length of the speaker's time needed.Event / Org WebsiteEstimated Audience Selected Value: 0 Gifts-N-Kind Submission:What would you like to donate? *Please provide as much detail of the item, quantity and condition that you would like to donate.Timeline I Would Like to Donate: *Within 2 WeeksWithin 30 daysWithin 3 MonthsWithin 6 MonthsSometime this YearI Would Like to Submit Via: *Attach E-Certificates/Vouchers/etcMail/Ship to 10.18 OfficeDrop Off with 10.18 RepHave a 10.18 Rep PickupSponsorship Request:Sponsorship Type- Select One -Church - Annual (Custom Payout Schedule Available)Church - EventChurch - One TimeCorporate - EventCorporate - Annual (Custom Payout Schedule Available)Corporate - One TimeCustom Plan Arranged with 10.18Event Sponsorship *- Select One -Awareness EventChristmas DriveCommunity OutreachFundraiser or GalaPlease select your most preferred type of event to sponsor. Custom Sponsorship Desired: *Please provide as much detail to the type of sponsorship you are desiring for your organization or group. If you have a specific goal in mind please let us know!File Upload Click or drag files to this area to upload. You can upload up to 3 files. Question/Comment:Submit
