Establishment Registration

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Thank you for your Establishment’s Offer to Support with the Asa’s Angels Christmas Outreach Program! We appreciate your support and because of your generosity we will be able to touch more hearts and lives of many children and families this holiday season in our local community. If your Establishment plans on Fundraising for the Asa’s Angels Holiday Outreach Drive, Please apply below to let us know how you would like to help!! Together, we can make a difference, one life at a time!

Email *

Business Name *

Primary Contact Name *

Address *

Please include City & Zip Code

Primary Contact Phone Number *

Email Address *

Please let us know how you would like to fundraise for our Holiday Outreach Program? *

Check all that Apply

Display Angel Gift Tags for Your Patrons to Purchase Gifts & Return to Your Establishment

Fundraise as an Establishment, Please Provide Further Details In Other:

Other:

Required

Would Your Establishment Like Us to Hang an Asa's Angels Gift Board to Display Your Angel Gift Tags on? *

Please note that Asa’s Angels is unable to Provide Christmas Trees

Yes, I would like a Gift Board

No, I will display on my Establishments Own Christmas Tree

Required

Please Share Any Additional Details or Notes, with us here! *

We would love to Promote Your Business through our Century 21 Asa Cox Homes Advertising for Patrons to Stop By and Pick Up a Gift Tag; via WKKY 104.7, Cougar 93.7, MIX 97.1, on our Asacoxhomes.com and Asasangels.com website. Do you give us Permission to do so? *

Yes

Required

A copy of your responses will be emailed to the address you provided.

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