New Event Form Name of Event * Event Location * Event State/ Prov. Code * AL-Alabama AK, Alaska AZ, Arizona AR, Arkansas CA, California CO, Colorado CT, Connecticut DE, Delaware DC, District of Columbia FL, Florida GA, Georgia HI,Hawaii ID, Idaho IL, Illinois IN, Indiana IA, Iowa KS, Kansas KY, Kentucky LA, Louisiana ME, Maine MD, Maryland MA, Massachusetts MI, Michigan MN, Minnesota MS, Mississippi MO, Missouri MT, Montana NE, Nebraska NV, Nevada NH, New Hampshire NJ, New Jersey NM, New Mexico NY, New York NC, North Carolina ND, North Dakota OH, Ohio OK, Oklahoma OR, Oregon PA, Pennsylvania RI, Rhode Island SC, South Carolina SD, South Dakota TN, Tennessee TX, Texas UT, Utah VT, Vermont VA, Virginia WA, Washington WV, West Virginia WI, Wisconsin WY, Wyoming Business Unit * Animal Nutrition (Purina) Corporate Dairy Foods Nutra Blend Supply Chain Truterra WinField United OTHER If you selected "OTHER" above, what business unit is the event for? How many days is your event * Event Start Date * MM DD YYYY Event End Date * MM DD YYYY Total Estimated # of Attendees * Planner Name * First Name Last Name Planner Email * Planner Phone Number * Phone number of invoice contact (###) ### #### Does your event require shipping of at-home COVID tests to attendees? * Yes No If yes, how many at-home test kits do you expect to send? Date COVID test to be delivered to attendees at their shipping address? **Please provide the attendee list with shipping details (name, full address & phone) at least 3wks prior to event to amanda.schleede@vitalcircle.health MM DD YYYY Any other details about the event? Thank you for your submission. The Land O’ Lakes Vital Circle team will be in contact in the next 48 hours to confirm your event. If this is an emergency event, please contact us at 312-515-3426 for assistance.
