Gorillas on the Line Registration Form

Organization name

Organization zip code

Contact name

Contact Email

Contact title

Have you participated in a collection drive in the past?

Yes No

Have you participated in the Gorillas on the Line Campaign in the past?

Yes No

Anticipated number of participants

Select all of the months you hope to participate

February March April May June July August

How do you plan to collect devices?

Anticipated number of drop-off locations and description

Why have you decided to “answer the call” this year?

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