Northwell Health Systems Registration

Address for Acknowledgement *

I would like to receive emails from Island Harvest *

Yes No
Expected number of participants in the food drive *
Food Drive Begin Date *

- Month - Day Year
Date
Food Drive End Date *

- Month - Day Year
Date
Our food drive goal in pounds is: *
Would your group be interested in hosting a Virtual Food Drive? *

Yes No Maybe- please send us information!
We will need a Food Drive Box (1'x1'x3') *

Yes No
We will be delivering our collected food to: *

Hauppauge Uniondale Our food drive is going to collect more than 500 lbs of food. Please send a truck!
Please share any additional information or details if applicable.
Should be Empty: