First Name

Last Name

Company

Email

City

State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia 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 Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Address One

Zip

How would you like to host this years Holiday Letter Drive? Online Letter Drive In-Store Letter Drive Online and In-Store Letter Drive Would you like to send physical letters from your store or direct supporters to send them using our online portal?

Would you like to host an LPP Fundraiser during this holiday season? Yes No

If you're a dispensary, how many dispensaries does your organization represent?

What is the total number of employees at your organization?

Dispensary Website

Store Manager Email

Social Media Handles

Anything else we should know?

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