Promotional Materials Request Form

Form Submitter Email Address (You)

Form Submitter First Name (You)

Form Submitter Last Name (You)

What type of promotional materials are you requesting?

Recipient's First Name

Recipient's Last Name

Is the recipient in Slate?

Yes

No

Recipient's Slate Reference ID (Nine digit number, top right of profile)

Recipient's Email Address

Recipient's Gender

Date of recipient's visit

Date of recipient's interview?

What candy/treat would you like us to purchase for the student?

What message would you like us to include in a card for this student as part of the mailer?

Please provide more information

Is recipient a prospective student athlete or in discussion with a PBA coach?

Yes

No

Not sure

Contact's First Name

Contact's Last Name

Contact's Email Address

Is contact's school/organization in Slate?

Yes

No

School/Organization Name

Organization's CEEB Code

Organization's Mailing Address

Country

Street

City

Region

Postal Code

Has PBA traveled to this school in past four years?

Yes

No

Not Sure

Promotional Items Requested (Select all that apply)

PBA Pennant

Info Packet/Brochure

Stickers

Other

Please describe "'Other'

Recipient's First Name

Recipient's Last Name

Recipient's Email Address

Is the recipient in Slate?

Yes

No

Recipient's Slate Reference ID (Nine digit number, top right of profile)

Recipient's Mailing Address

Country

Street

City

Region

Postal Code

Promotional Materials Requested (Select all that apply)

Who is requesting promotional items?

Please describe 'Other'

Name of Organization

First Name of Individual Requesting Materials

Last Name of Individual Requesting Materials

Email Address of Individual Requesting Materials

Could you please describe the relationship between the individual requesting the materials and the recipient?

Promotional Items Requested (Select all that apply)

PBA Pennant

Info Packet/Brochure

Stickers

Other

Please describe 'Other'

Will the promotional materials be delivered by mail or picked up by individual?

Mailed

Picked Up

Provide recipient's mailing address

Country

Street

City

Region

Postal Code

When should the materials be ready for pick up?

The time on that day?

Any additional information to provide?