CINCH Outreach Application Application must be received a minimum of 2 weeks prior to the event.State/ Province:(Required) National Director:(Required) State/Provincial Secretary:(Required) Names of Participating Members:(Required) Location of Event:(Required) Start Date of Event(Required) MM slash DD slash YYYY Descritption of Event(Required) NHSRA Promotional ItemsList quantities for items you would like to receive. NHSRA Video ContentNHSRA Pamphlets/BrochuresNHSRA BannersNHSRA Times MagazinesWhat NHSRA items would you like as your first, second, and third choice? CINCH Outreach Promotional ItemsMust order a MINIMUM of 25 of each item picked. Must order a MINIMUM of 36 water bottles. Not all items requested are guaranteed but WILL be considered.CINCH Aluminum Water BottlePlease enter a number greater than or equal to 36.CINCH Plastic Water BottlePlease enter a number greater than or equal to 36.CINCH Drawstring BagPlease enter a number greater than or equal to 25.CINCH FrisbeePlease enter a number greater than or equal to 25.CINCH Hat PatchPlease enter a number greater than or equal to 25.CINCH LanyardsPlease enter a number greater than or equal to 25.CINCH Note PadsPlease enter a number greater than or equal to 25.CINCH PensPlease enter a number greater than or equal to 25.CINCH Pick n MintsPlease enter a number greater than or equal to 25.CINCH Sticker SheetPlease enter a number greater than or equal to 25.CINCH Sunscreen PensPlease enter a number greater than or equal to 25.What CINCH items would you like as your first, second, and third choice? The materials requested will be mailed/emailed to the address provided on this form below:Name(Required) First Last Email(Required) Phone(Required)Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Remember to fill out a CINCH Outreach Summary Report through the NHSRA website within 30 days of the last day of the event.
