Small Business Partner sign-up form
Silent auction donors, micro-event hosts, and locations hosting a donation box.
Primary contact information
Please enter information for you or your business.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Information
Information shared below will be used on www.MidlandRestaurantWeek.com website.
Business Name
*
This is how your name will be down to the public
Instagram Handle
Example: @MidlandRestaurantWeek
Facebook Page Link
Example: facebook.com/MidlandRestaurantWeek
LinkedIn Profile Link
Example: linkedin.com/company/shelterhousemidland/
To be recognized as a Small Business Partner, you are asked to display a Shelterhouse Donation Box at your establishment during Sexual Assault Awareness Month, April 2023. How many donation boxes will you need?
*
Please upload your logo to be used on MidlandRestaurantWeek.com and on social media.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Do you authorize Shelterhouse Midland Restaurant Week to use images from your website and/or social media pages to promote your participation in this event?
Yes
No
How will you be partnering with Shelterhouse during Midland Restaurant Week?
Donating a silent auction item
Hosting a micro-event during MRW
Collecting donations at location for Shelterhouse
Other
"Other"
If you selected "other," please describe.
Collecting donations at location
Will you be providing your own donation box or do you need to be supplied with one?
Providing our own
Please supply us with one!
Any other details?
Hosting a Micro-Event
When will the event take place?
-
Month
-
Day
Year
Date
What time will the event start?
Hour Minutes
AM
PM
AM/PM Option
When will it end?
Hour Minutes
AM
PM
AM/PM Option
Please describe the event.
Silent Auction Donation
Please tell us a little about the item that you would like to donate.
Item name
Item value
Item description
Is this item a gift certificate?
Yes
No
Will this item be dropped off?
Yes
No, but it can be made available for pickup
Collection Details
Please specify any special delivery/pickup details, including preferred pickup date/time
Submit
Should be Empty: