BBRN Referral Form

BBRN Referral Form

An email will be sent to the referral recipient and you will receive a copy for your records. If you select GREEN SLIP, it will send the information to Aaron.
TESTING for first time users: please confirm your contact info by sending a TO and FROM yourself. Let Susan know if it needs to be corrected.
Is this a:*

New Referral"GREEN SLIP" to report $$
Send email copy to REFERRAL chair?*

Send (will NOT submit paper form)NO (I will submit a paper form at a meeting or this is a TEST or a COOL lead)
REFERRAL FORM
NOTE: If this is a GREEN SLIP, put YOUR name in the REFERRAL TO section and who you got the referral from in REFERRAL from.

Referral Details
Referral type:*

INSIDEOUTSIDE"COOL"
*NOTE: A "cool" referral is one where the contact is NOT expecting a call. You are just sending the contact information. The referred member will not receive a copy AND it will not count as a referral per your BBRN commitment.
Date*

MonthDayYear
Date
Person to Contact*

First NameLast Name
Contact phone*

Area CodePhone Number
Contact email
example@example.com
Referral note (message to send to the contact)*

REFERRAL FORM