Business Name:   

CEO Name: 

Name of Person filling out this form: 

Email: 

Dates of Campaign (estimate is okay): 

Number of employees at your business: 

Campaign Supplies
:  # Campaign Pledge Form
:  # Campaign Brochure (information to give to employees who are hired after your kick off)
:  # New Hire folder
:  # Campaign DVD - you can also download our DVD on-line - click here
:  # Live United buttons 

Goal Poster  - 11" x 17" full color
:  # Campaign Goal Posters
                 

Double sided posters - 11" x 17" full color
:  # Campaign Poster 1
                

:  # Campaign Poster 2
                   

 :  # Campaign Poster 3
                   

Yes - I'd like more information on conducting an electronic campaign

Yes - I'd like more information on having a Speakers Bureau Presentation or click here

Yes - I'd like to be connected with an ECC MENTOR

ECCs - I am not able to attend the ECC Workshop but need T-shirt(s) - please include # needed by size:

     Small   Medium  Large   XLarge   XXLarge

 Additional Information

 Authorization Code:

Enter Above Code: