Outreach Form Save my progress and resume later | Resume a previously saved form Resume Later In order to be able to resume this form later, please enter your email and choose a password. Your Email: A Password: Confirm Password: YOUR INFORMATION Your First and Last Names PURPOSE OF SUBMISSIONPlease select... Claim A Contact (With Review) Report on Appeal/Contact POTENTIAL/CURRENT SPONSOR/SUPPORTER RegionPlease select... Cincinnati Chicago First Name: Last Name: Preferred Salutation (Dear XX) If first name is different from proper name listed above Title REQUIRED: Associated Company/Organization Name City StatePlease select... AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Email Address (An email address is required to add/update the contact record in our system.) Mobile Phone Work Phone Home Phone YOUR RELATIONSHIP TO THE INDIVIDUAL/ORGANIZATION Strength of your connectionPlease select... 4 - Extremely Strong 3 - Very Strong 2 - Familiar 1 - Somewhat Familiar Information About Your Relationship with the Contact THANK YOU FOR LETTING US KNOW YOU HAVE A CONNECTION TO THIS PERSON/COMPANY. If you haven't already received direction from us and if a response is not time-sensitive, please give us 2 business days to determine the best time to connect with them. Report Subject(s): (Select all that apply)Patient/Family: Program/ServiceFundraising: Event(s)Auction Item SolicitationThe LandingStudent Ambassador ProgramCo-Branding (Other)Group Volunteering REQUIRED: Is This Person The Best Person To Speak With On The Subject? YesNoIf NOT, please add any additional names at the bottom of this form in the "Next Steps" section. Event Sponsorship Opportunities 8/24 Rock & Roll Chalk Fest? Please select... Considering Confirmed Paid Unlikely; Check Next Year Declined; NOT Interested Not DiscussedClick Here For Details 8/27 Performance Golf Invitational? Please select... Considering Confirmed Paid Unlikely; Check Next Year Declined; NOT Interested Not DiscussedClick Here For Details 9/27 Night of Courage? Please select... Considering Confirmed Paid Unlikely; Check Next Year Declined; NOT Interested Not DiscussedClick Here For Details 2/22 Grand Gala? Please select... Not Discussed Considering Confirmed Paid Unlikely; Check Next Year Declined; NOT InterestedClick Here For Details 5/11 Dragonfly Golf? Classic?Please select... Not Discussed Considering Confirmed Paid Unlikely; Check Next Year Declined; NOT Interested 6/13/2020 Motorcycle Ride?Please select... Not Discussed Considering Confirmed Paid Unlikely; Check Next Year Declined; NOT Interested Patient/Family Program: Specific Areas of Interest GiftingUrgent NeedsTickets/SuitesPatient/Family Events (Other)Care BagsTechnologyAdopt-A-FamilyBooksFinancial Support for FamiliesFuneral Costs/ExpensesSelect All That Apply Level of Support/Sponsorship Discussed ($ Amount, Type of Item, etc.) (255 Char. Max) Likelihood of SupportPlease select... Considering Committed Support Paid Unlikely Declined; Not Interested NEXT STEPS Who Should Followup Next?Please select... Ria/Christine Greg Vehr Mary Tignor Amy Hafner (SAP) Me Any Dragonfly Rep. Staff Notes: Greg Vehr is our Senior VP of Development (responsible for our Landing fundraising), Mary Tignor is our Community Relations Manager (responsible for volunteers and events) and Amy Hafner manages our Student Programs. When?Please select... ASAP The Next Event 6 Months 1 Year Do Not Contact At All Recommend Approach? EXTRAS Were any other potential sponsors identified? (Please provide, Name, Relationship, Phone/Email, Details, etc.). Thank you for helping us track the activities of our External Relations Committee. Save my progress and resume later | Resume a previously saved form Having Trouble? Click Here.
