Give The Chicken Nomination Form
Once you've read over http://www.GiveTheChicken.com come back and fill out this form.

Not everyone that is nominated will receive crowd funding support from Rent The Chicken. If you have questions you can reach us in the USA at 724-305-0782 or in CANADA at Toll-Free at 844-310-8782.

Your Name (First and Last) *
Your answer
Your Phone Number *
Your answer
Your Email Address *
Your answer
Your Mailing Address *
Your answer
Would you like to remain anonymous in this process? *
Is your nomination for Rent The Chicken or Hatch The Chicken? *
Name of the Nomination (If a Library, School, or other facility please put the business name AND the main contact at the facility) *
Your answer
Delivery address *
Your answer
Nominee's Phone Number *
Your answer
Nominee's email address (if known)
Your answer
Is the Nominee a Non-Profit? *
Are you available to be video interviewed by Rent The Chicken if your nominee is selected? We will use this video to help promote the nominee. *
Are you willing to promote your nominee's crowd funding support? (sharing the information with friends, family, and orginizations, maybe even sending out pre-formated press releases to the local news agencies) *
Please tell us why you selected this nominee. *
Your answer
Is there anything else we should know?
Your answer
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