Short Form - The info at top of page is all we need to have you sign up to become '1 of 52' in your state.
Today's Date: _______________
[ ] Yes, I would like to participate in the 1 of 52 Hunger
Network!
Your name: ______________________________________________________
(Optional signature: ______________________________________________ )
Name of company / artist: __________________________________________
Mailing address: _________________________________________________
Phone: _________________________________________________________
Fax: ___________________________________________________________
Email: _________________________________________________________
Web site: _______________________________________________________
(Short Form Complete.)
(Below: More/Optional info if available/known.
This info not required to join up at this time.)
Alternate contact: _________________________________________________
Agency: ________________________________________________________
Management: ____________________________________________________
Phone/Fax/Email/Web site: _________________________________________
_______________________________________________________________
Location of event: _________________________________________________
Phone number and address of venue: __________________________________
Contact person at venue: ____________________________________________
Show times/details: ________________________________________________
Tickets available in advance? _______ Prices $___________________________
Others on bill in order of appearance: __________________________________
Media contacts: ___________________________________________________
________________________________________________________________
________________________________________________________________
Describe show/act/work:
________________________________________________________________
________________________________________________________________
Other details, comments, activities to be held:
Please print this information form, copy it,
and share it with others who might like to join the network.