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Flyer Distribution Request Form

Form 4060F

4000 Series- Community Relations

Flyer Distribution Request

Name of Organization

Answer required for "Name of Organization"

Address

Street Address

Answer required for "Street Address"

City

Answer required for "City"

Zip/Postal

Answer required for "Zip/Postal"

First Name

Answer required for "First Name"

Last Name

Answer required for "Last Name"

Phone Number

Number Required

State the educational value the program provides students (must be a non-profit organization):

Answer required for "State the educational value the program provides students (must be a non-profit organization):"

Signature*

Signature Required

Please attach a sample of the flyer you wish to have distributed.

All materials distributed must contain the following statement: "The Centralia School District does not sponsor this event and the District assumes no responsibility for it."

Sample of Flyer

Answer required for "Sample of Flyer"

Choose a file or drag it here.

How are you wanting the flyers distributed?

Answer required for "How are you wanting the flyers distributed?"

Electronic distribution

Paper distribution

Please note the following average student counts for each school: (The Organization will be responsible for the copies being printed and counted out for each individual school-- for elementary, please have your stacks in groups of 25 for ease of classroom mailboxes)

CHS- Posters Only; CMS- 50 for counter posters; ED- 309; FP- 434; JL- 330; OAK- 315; WA- 294

Confirmation Email

Confirmation Email *

Answer required for "Confirmation Email"