(Central Wellness Coalition) Promotions E-mail Form

Request for Discretionary Funding and/or Promotional Items

Please note that all fields are manditory!

Name:
Organization:
E-mail Address:
Phone number:
Mailing address:
Name of Event:
Date:
Location:

Expected number of participants:

Request Details:

Promotional Items: Discretionary Funding ( max 200.00 ):

Event Discription:Please indicate below what you intend to use the funding or promotional items for?

All foods purchased must follow CRWC Health Eating Guidelines for community events.

If you are not currently a networking member, by submitting this application you agree to be added to the Central Regional Wellness Coalition networking membership. With this you will receive updates, information and emails from the CRWC. Note that the CRWC does not share email addresses or personal information with outside sources. Emails you will receive from the CRWC will only contain educational information or wellness /funding opportunities for members.