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Canned Food Drive Participation Form
Participating Organization:
*
Contact:
*
Address 1:
Address 2:
City:
State:
AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
FM
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MH
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PW
PA
PR
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
WY
Zip:
Day Phone:
*
Alternative Phone:
E-mail:
*
Food Drive:
Start Date:
End Date:
Extended to:
Number of Barrels Needed
Barrel Location(s):
Time to pick up barrel(s):
Please Select Preferred Time
9am - Noon
1pm - 4pm
After Business Hours / Weekend
Additional Requirements
Office Use Only:
deleivered / taken:
by:
picked up / returned:
by:
total poundage received:
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