National Work Zone Memorial Host Application Form

The ATSS Foundation Digital National Work Zone Memorial Host Application Form

Respect and Remembrance: Reflections of Life on The Road

Submit this form to request to host the digital National Work Zone Memorial. The ATSS Foundation will review your request before you will receive the link to the digital Memorial.

HOST CONTACT INFORMATION

1. Primary Contact Name*

First NameLast Name

2. Host Organization Name*

3. Address*

Street Address

Street Address Line 2

CityState

Zip Code

4. Primary Contact Phone Number*

Please enter a valid phone number.

5. Primary Contact Email (needed to send link to digital Memorial)*

example@example.com

6. Name of Event or Conference*

7. Event Start Date*

Date

8. Event End Date*

Date

9. Event Website (if applicable)

10. Venue Name (if not an in-person event, enter "virtual")*

11. Address

Street Address

Street Address Line 2

CityState

Zip Code

12. Estimated number of attendees to view digital Memorial*

13. Preferred Event Handle (@):

14. Preferred Event Hashtag(s) (#)

15. Is there anything else you would like us to know about your event?

The ATSS Foundation Traveling National Work Zone Memorial Host Application Form

Respect and Remembrance: Reflections of Life on The Road

Submit this form to request to host the traveling National Work Zone Memorial. The ATSS Foundation will review your request and will confirm in writing the traveling Memorial's availability for your requested dates.

HOST CONTACT INFORMATION

1. Primary Contact Name*

First NameLast Name

2. Host Organization Name*

3. Address*

Street Address

Street Address Line 2

CityState

Zip Code

4. Primary Contact Phone Number*

Please enter a valid phone number.

5. Primary Contact Email*

example@example.com

PREFERRED DATES FOR MEMORIAL VISIT

The ATSS Foundation recommends a maximum 4-day visit, in order to focus community attention most effectively. The ATSS Foundation will do its utmost to make the Memorial available to your organization on the requested dates. However, scheduling and travel requirements may cause us to ask for patience or flexibility, so that we may satisfy the needs of as many prospective hosts as possible. You will receive confirmation of the visit and dates in writing. The hosting fee is $950. You will receive a contract and invoice prior to your event.

Please provide your preferred shipping arrival and departure dates for the Memorial to facilitate shipping arrangements.

6. Memorial Shipping Arrival Date *

Date

7. Memorial Shipping Departure Date*

Date

EVENT LOCATION INFORMATION

8. Name of Event or Conference*

9. Venue Name*

10. Address*

Street Address

Street Address Line 2

CityState

Zip Code

11. Event Start Date*

Date

12. Event End Date*

Date

13. Estimated number of attendees to view Memorial*

14. Event Website (if applicable)

EVENT SOCIAL MEDIA (ATSS Foundation may promote your event on social media)

15. Preferred Event Handle (@):

16. Preferred Event Hashtag(s) (#):

17. Is there anything else you would like us to know about your event?

MEMORIAL HOST SPONSER (for Memorial contract and invoice)

Please complete section if the host fee sponsor is different than the Host Contact Information.

18. Organization Name

19. Contact Name

20. Email

example@example.com

SHIPPING LOCATION

If the shipping location is a tradeshow or conference, the Memorial host must coordinate directly with the conference for shipping details and handle any materials handling fees with the conference. The ATSS Foundation is not responsible for any shipping warehouse fees, materials handling fees, electricity fees, and similar conference expenses on behalf of the Memorial host.

21. Organization*

22. Onsite Contact Name*

First NameLast Name

23. Shipping Address*

Street Address

Street Address Line 2

CityState

Zip Code

24. Is there anything else you would like us to know about your shipping location?

The ATSS Foundation National Work Zone Memorial Application

Digital Memorial:

Traveling Memorial: