Generation FREE Activity Team Report - The Partnership for a Healthy Mississippi

Organization Name*

Team Name*

Sponsor's Name*

First Last

Phone Number

Email Address*

Date of Activity*

Shipping Address (No PO Boxes)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

County*

MTFC Director*

Title of Activity*

Activity Topic*

Comments/Suggestions

Did media cover the event?

Which media outlets covered the event?

# of FREE team members who participated in the activity*