DC Dine11.org Hospital Partner Sign Up Form
Please complete this form to participate as a Hospital Partner in Dine11 - Washington D.C.
Name Of Hospital *
Primary Address *
Primary Contact *
Primary Phone Number *
Primary Email *
Drop Off Location *
OUR DRIVERS NEED TO KNOW LOCATION & SPECIFIC DIRECTIONS FOR ALL DROP OFFS
Number To Be Called Upon Drop-Off *
OUR DRIVERS ARE INSTRUCTED TO STAY OUTSIDE DURING THE DROP-OFF PROCESS
Lunch Shift - Head Count *
Lunch Shift - Time *
Time
:
DInner Shift - Head Count *
DInner Shift - Time *
Time
:
Best Delivery Days *
Required
Urgent dietary restrictions - If any
Submit
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