Name of Non-Profit Group Requesting Assistance: *
Headquarters Street Address:
City/State/Zip Code:
What is the purpose and/or nature of this group?
Size of paid staff?
What is the group's sales tax number?
Contact person:
Address (if different from above):
City/State/Zip Code:
What local or national mechanism exists for distribution of information and materials?
Is the group currently utilizing "public service" announcements (PSA's) from broadcast or print media? If so, please list media:
If PSA's were not produced by the media donating space, how were they produced? Please explain by who and at what cost to the group.
What result vehicle do you have in place to measure results?
If your organization is selected for this campaign, the Black Hills Advertising Federation will coordinate and design a concept for an awareness campaign utilizing donated media time and space.
Objectives of campaign ( limit to 3)


Target audience(s) (limit to 3)