Home / SustainabilityLocal Change / Australian Sustainability Event Request Form

*Associate Project Coordinator:
*Associate ID #:
*Associate Home Phone #:
*Associate Mobile Phone #:
*Email:
*Street Address:
*City:
*State:
*Postal Code:
Alt Associate Contact:
*Home Phone #:
*Mobile Phone #:
Email:
*Non-Associate Contact:
*Organization:
Phone #:
*Email:
Event Website
ex: http://www.youreventwebsite.com

Suggestions for local newspaper for event PR:
Suggestions for local photographer:
(not all events will have a photographer attend.)

*Project/Event Name:
Project Details:
*Date:
*Time:
 
*Event Address:
*Event City:
*Event State:
*Meeting Location:
Alternate Date:
Event Open to Public?:
Yes No 
Free to Attend?:
Yes No 
All Ages?:
Yes No 
*How many Viridian-affiliated volunteers would you estimate participating?:
Please note each of the following items that would be helpful to have provided by Viridian:
 T-Shirts Bags Tools Gloves Food
Other Helpful Items:
Additional Notes on project request: