Name*  

  Title  Select One Fund Raising Coordinator President/Group Leader Vice President Secretary Treasurer

Group*  

City*  

  State 

E-mail*  

Home Phone*  

  Work Phone 

Best Time to Call  

Select One Anytime 9:00 am - noon Noon - 3:00 pm 3:00 pm - 6:00 pm 6:00 pm - 9:00 pm

Group Web Site  

Group Type  

Select One Athletic/Sports Group Church - School Church - Youth Group Church - Other Day Care Elementary School Elementary School PTA/PTO Middle/Junior High School - Group Middle/Junior High School - Sports Middle/Junior High School -  Other High School - Group High School - Sports High School - Other Private School - Group Private School - Sports Private School - Other Work - Non-profit Work - Other Other

Group Size*  

Dollar Goal  

Select One < $500 $500 - $999 $1,000 - $2,499 $2,500 - $4,999 $5,000 - $9,999 $10,000 - $19,999 $20,000+

Start Date 1  

mm/dd/yy

Start Date 2  

mm/dd/yy

Start Date 3  

mm/dd/yy

Products of Interest

"M&M's"® Candies  Hershey's® Chocolate  Scratch & Help® Cards

What other products are you considering?

Has your Group sold candy in the past?

Yes  No

  If Yes, what candy did you sell?

How often does your group conduct a Fund Raising Campaign? 

Select One Once a year Twice a year 3 - 4 times a year 5 - 6 times a year Monthly