Please completely fill out the following information so that we can better understand and fill your request. Give us as much detailed information as possible.

Please note that the IMPACT worksheet is not a contract. The IMPACT Worksheet is required in order to evaluate your request to have Frontline Youth Communications come to your community.

Please include additional information, if necessary, in the space provided to help us better understand the scope of your event.

Upon receipt of this form, we will be in touch with you regarding our availability for your event.

Where did you hear about Frontline Youth Communications?

Where did you hear about our speakers?
If you selected "Other", please describe:
Has David appeared for your organization before?
If yes, please give all prior events and dates:

Contact and Organization Information

Organization Name:
Contact Name:
Street Address:
City State Zip
Telephone Number (Example: 123-123-1234):
Fax Number (Example: 123-123-1234):
Email Address:

About the Event

Type(s) of event or project you are interested in (please check all that apply):
 
School Assemblies Youth Conference
Church Event Points of IMPACT Workshop
Parent Meeting Fundraising Banquet
Interactive Website Community Rally
IMPACT First Package Music that Moves Concert
PeerPositive Program FrontlineGear Product order
Professional Development Incarcerated Youth Services
Promotional Materials (posters, billboards, brochures, etc.)

If scheduling with other schools in your area, travel time between schools cannot be more than 45 minutes.

Scheduled Date(s) of the Event or Project Start Date(s):

Please note that evening events for David Mahan must have a minimum of 150 people attending and be approved by our office.

Briefly describe the following:

Proposed Event or Project:
Targeted Audience(s):
Expected Attendance for Each Event or Project:
Allocated Budget for Each Event or Project:
Will you be needing any Frontline message reinforcers? (Pledge cards, Posters, CD's, T-shirts, Web cards...):
Goal / Purpose of the Event or Project:
Nearest Major Airport:
Event Distance from Airport (miles):

Additional Information

Additional Event or Project Information: