Name of Organization or Landmark to "GO BLUE" - please list EXACTLY as it should be listed on the website, map, and press release.
Your answer
City where landmark or organization is located
Your answer
Physical street address of landmark or organization
Your answer
Your mailing address (if different from physical address)
Your answer
Name and contact information for venue or landmark (if different than you).
Your answer
Date(s) the organization or landmark will GO BLUE.
Your answer
What is your organization or landmark doing to GO BLUE? (Exterior lights, internal employee engagement, patient or customer engagement, etc.)
Your answer
Organization or Landmark Twitter handle
Your answer
Organization or Landmark Instagram handle
Your answer
Are you requesting a proclamation from your city's mayor? (If yes, please email erin@coloncancercoalition.org when proclamation is confirmed. A list of cities will proclamations will be included on the website, map, and press release. Deadline to be listed is Friday, February 14, 2020.
Clear selection
Thank you!
You may submit this form again for another landmark or location.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Colon Cancer Coalition. Report Abuse