Registration Form

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thINK Food Registration

Date of Registration:

* Required fields are underlined and bold.

Name of Collection Site:

Mailing Address of Collection Site:

Street Address of Collection Site (if different):

City/Town

Postal Code

City/Town

Postal Code

Closest Major Intersection:


Name of Primary Contact:				Title:
	Phone Number:		ext:

	Fax:
	Email:
		Can we contact you via email to save project resources?
Hours of Operation for Pick-ups:


Name of Secondary Contact:			Title:
	Phone Number:	ext:

	Fax:
	Email:

Material Required:

Box

Posters

Handouts

Do want your site to be:

PUBLIC Drop Off

Internal collection

Location is a:

School

Church

Company

Shopping Mall

Grocery Store

Private Residence

Government Office

Other

If Other please state:

Are you collecting:

Inkjets

Lasers

Cell phones

(Please note that it is only possible to collect lasers in some regions and lasers should not be put in the inkjet boxes. Phone 1-888-271-3641 for information about your area)

How did you hear about this project?