| Personal Information |
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 | Enter a valid phone number. Example: 123-456-7890 |
 | Enter a valid email address. Example: name@company.com |
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| Organization Information |
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| Is your organiztion a elementary school? |
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| Organization Website (if applicable) |
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| Organization Activity (check all that apply) |
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| Organization's Primary City |
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| Organization's Primary State |
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| Please specify which key market your organization is located in: |
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| What percentage of participants are within the ages of 3-11 for the activities you are listing in this application? |
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| Event/Activity #1 Information |
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| Number of participants ages 3-11 at the event/activity |
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| Shipping Address for Event/Activity (if different from above) - NO P.O. BOXES PLEASE! |
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| Is this a residential address? |
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| Event/activity #2 Information |
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| Number of participants ages 3-11 at the event/activity |
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| Shipping Address for Event/Activity (if different from above) - NO P.O. BOXES PLEASE! |
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| Is this a residential address? |
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| Event/activity #3 Information |
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| Number of participants ages 3-11 at the event/activity |
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| Shipping Address for Event/Activity (if different from above) - NO P.O. BOXES PLEASE! |
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| Is this a residential address? |
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| Event/activity #4 Information |
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| Number of participants ages 3-11 at the event/activity |
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| Shipping Address for Event/Activity (if different from above) - NO P.O. BOXES PLEASE! |
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| Is this a residential address? |
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| Other Information |
| Would you be willing to provide 3-5 photos of your participants enjoying the samples and event feedback? |
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| Would you be willing to place the R.W. Knudsen Sensible Sippers logos on any collateral pieces (banners, flyer, website, etc) as available? |
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| If you have any questions or comments about this sampling program, please provide them here: |
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| By submitting this application form you agree to distribute the Annie's Cheddar Bunnies and R.W. Knudsen Sensible Sippers samples from July 28 through October 12, 2008 to participants ages 3-11 through event bags, registration packs, coaches distribution, etc., including but not limited to team sports, schools, community recreation activities and athletic events. |
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| By submitting this application you agree and understand that the sale, barter or any type of misuse of provided samples will result in your immediate termination from the program and any future sampling opportunities. |
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