Workplace Solutions, Building a healthy workforce.

• Name of Company:
  
• Headquarter Address:
  
• Headquarter City:
  
• Headquarter State:
  - Select State - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Oregon Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
• Headquarter Zip Code:
  
• Headquarter Website:
  

• Volunteer Leader
• Name:
  
• Address:
  
• City:
  
• State:
  - Select State - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Oregon Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
• Zip Code:
  

• Email Address:
  
• Phone:
  
• Mobile:
  
• Fax:
  

• Senior Leadership/CEO sponsors of Relay for life National Team Program
• Name:
  
• Title:
  
• Name:
  
• Title:
  

• Please answer the following questions to provide valuable information to the American Cancer Society to help us continue building our relationship with you while maximizing the Relay For Life opportunity for your corporation and better supporting your community Relay teams.

• Support
• To engage your company in Relay For Life communities nationwide, who is the person (i.e. local manager, community involvement coordinator, etc) we should contact at each local site?
• 
• In our experience, your program will be most successful if we have an accurate list of contact names and phone numbers from each of your sites so Society staff can offer local support and recognition of your National Team Program efforts. Will you be able to supply us with a list of locations and contacts to assist our staff with outreach and recruitment?
• Yes     No
• 
• Does your company have a community volunteer program?

• Marketing and promotions
• What is your internal marketing and communications plan for promotion of Relay For Life in your company, including general information about this program, as well as the ongoing support of your company team captains and volunteers (district manager meetings, conference calls, Intranet postings, interoffice memos, meetings, etc.)?

• Does your company, club, association or organization offer local sponsorship opportunities with Relay For Life that may give your company additional exposure and recognition?
• Yes     No
• 
• If yes, who do we approach for sponsorship at your locations?
  Please include the title or role of person in charge of sponsorships at the locations in communities.
• 
• What is the timeline for proposals and format requested? Is there an application process?
• 
• How is this promoted and decided at local office locations?
• 
• Does the American Cancer Society meet your company guidelines for the following:
  
  Matching gifts?
• 
• Corporate foundation funding?
  If so, please tell us what corporate grants or foundation programs company
  teams may apply for in support of the American Cancer Society.
• 

• Leadership commitment
• Describe your CEO /senior executives’ role with this initiative.

• 2012 status of Relay For Life teams nationwide
• Number of Relay teams:
• Team monies raised:
• Matching gift and foundation grant funding:
• Corporate sponsorship dollars invested:

• Who is your ACS Staff Relationship Manager?
• First Name:
  
• Last Name:
  

Please email jpg and eps vector format logo and any supporting documents, photos, or testimonials to acsworkplacesolutions@cancer.org