PTW COMMUNITY PARTNER/HOST SITE AGREEMENT
The details provided below will be used to complete the partner/host site agreement. We will send you a copy of the final agreement to sign.
Community Partner/Host Site Name
*
Host Site/Community Partner Location
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Screening Event Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Point of contact name:
*
First Name
Last Name
Point of contact email:
*
example@example.com
Point of contact phone number:
*
Please enter a valid phone number.
Format: (000) 000-0000.
Partner organization/Host Site will promote the screening event in the following ways:
*
Rows
Promotion Method
Expected # of individuals to be reached
Promotion Method 1
Promotion Method 2
Promotion Method 3
Promotion Method 4
Promotion Method 5
NKF AZ will initiate posts regarding the event and tag the Community Partner to share with their followers. Partner organization social media tags:
Rows
Social Media Tag(s)
Instagram
Facebook
X
LinkedIn
Partner organization/Host site will help to recruit volunteers as follows:
Partner organization has relationships with and/or recommends including the following clinics and/or social service organizations (please include a point of contact for the organization, if known):
Rows
Organization Name
Point of Contact Name
Email
Phone Number
Services Provided
Organization
Organization
Organization
Organization
Organization
If the ideal quantity/type of tables and chairs is not available, please indicate the total number of tables and chairs available below:
Rows
Number of items available
Six-foot rectangular tables
Eight-foot rectangular tables
Large round tables (seats 6 or more people)
Chairs
The point of contact for Host Site administrative questions and authorized approvals will be:
First Name
Last Name
Email
Area Code
Phone Number
The point of contact for Host Site logistical questions will be:
First Name
Last Name
Email
Area Code
Phone Number
Submit
Should be Empty: