Thank you for your interest in our “24 for 24” initiative!

PLEASE COMPLETE THE SHORT FORM BELOW.

YOUR NAME

Must provide a valid name.

First Name

Last Name

YOUR EMAIL ADDRESS

Please provide a valid email. This will be the primary form of contact. By providing your email address, you understand that you will receive communication and information in relation to Alark Co. WE DO NOT SELL OUR EMAIL LIST.

YOUR MOBILE NUMBER

Please provide a valid phone number. This will be the secondary form of contact if we need to contact you in relation to this initiative. By providing your phone number, you understand that you will receive communication and information in relation to this initiative. WE DO NOT SELL OUR PHONE LIST.

INFORMATION ABOUT YOUR NOMINEE

NOMINEE'S NAME

Must provide a valid name.

First Name

Last Name

NOMINEE'S EMAIL ADDRESS

Please provide a valid email. This will be the primary form of contact. By providing their email address, you understand that they will receive communication and information in relation to Alark Co. WE DO NOT SELL OUR EMAIL LIST.

NOMINEE'S MOBILE NUMBER

Please provide a valid phone number. This will be the secondary form of contact if we need to contact the family in relation to this initiative. By providing their phone number, you understand that they will receive communication and information in relation to this initiative. WE DO NOT SELL OUR PHONE LIST.

Based on the following factors for consideration: Family size (number of dependents); Health issues, disability, or chronic illness; Recent hardships and challenges (eg. job loss, divorce, bereavement, or alike); please clearly explain WHY you are nominating this family for a holiday hamper. Thank you.