Support POAC: Dress Down Days Interest Form

Dress Down For POAC and Autism Awareness
Get Casual for a Cause

Your company's involvement:
1. Please complete the form below. All fields are required unless otherwise noted. Questions can be emailed to info@poac.net.

2. Appoint a liaison from within your company to recruit employee participants, collect their donations, and distribute the stickers.

3. Display "Dress Down for Autism Awareness" flyers throughout your company's premises and inform employees of the event

4. Ask participants to wear a sticker and "Dress Down" on any day or your choice. Convert all donations to a check payable to POAC and return, along with the participant registration sheet.

POAC will provide:

• Autism awareness stickers for participating employees/students
• Event flyers and information about POAC and autism sample article for your company/school newsletter or for email distribution (Please allow one week for the delivery of your materials)

Fields marked with an asterisk * are required.

COMPANY OR SCHOOL INFORMATION
* Company or School Name:
* Address 1:
Address 2 (Optional):
* City:
* State:
* Zip Code:
CONTACT PERSON INFORMATION
* Name:
* Title:
* Phone:
* E-mail:
* Fax:
* Number of Stickers Needed:
* Digital Signature: Simply type your name, first and last, which will act as your digital signature.