<h3 class="f3">Contact</h3>
<h5>*all fields required.</h5>
<div class="col-sm-5 col-md-6 col-xl-12">First Name
[text firstname]
</div>
<div class="col-sm-5 col-md-6 col-xl-12">Last Name
[text lastname]
</div>
&nbsp;
<div class="col-sm-12 col-md-12 col-xl-12">Name of Organization/ Group
[text organitationname]
</div>
<div class="col-sm-12 col-md-12 col-xl-12">Phone*
<div>
[tel* telephone]
</div>

</div>
&nbsp;
<div class="col-sm-12 col-md-12 col-xl-12">Email Address*
[email* email]
</div>
</br>
<div class="col-sm-5 col-md-6 col-xl-12">
Event Location
[text eventlocation]
</div>
<div class="col-sm-5 col-md-6 col-xl-12">Expected Attendance
[text attendance]

</div>
&nbsp;
<div class="col-sm-12 col-md-12 col-xl-12">Event Date*
<div style="width: 100px; float: left;">&nbsp;&nbsp;&nbsp;
<label>Month</label>
[select menu-808   "Jan" "Feb" "March" "April" "May" "June" "July" "Aug" "Sep"  "Oct" "Nov" "Dec"]
</div>
<div style="width: 100px; float: left;">&nbsp;
<label>Day</label>
[select day   "1" "2"]
</div>
<div style="width: 100px; float: left;">&nbsp;
<label>year</label>
[select year  "2014" "2015" "2016"]
</div>
</div>
&nbsp;
<div class="col-sm-12 col-md-12 col-xl-12">Please tell us about your event and why GRBC should donate to your cause*
[textarea textarea-158 85x1]
</div>
&nbsp;
<div class="col-sm-12 col-md-12 col-xl-12">What type of donation are you seeking? (Swag bag for silent auction, meeting space or other donation.)
[textarea textarea-67 85x1]
</div>
&nbsp;
<div class="col-sm-12 col-md-12 col-xl-12">Are you a tax-exempt 501(c)3 or 501(c)6 organization? (if yes, please include tax exempt number.)
[textarea textarea-772 85x1]
</div>
&nbsp;
<div class="col-sm-12 col-md-12 col-xl-12" style="padding-bottom: 10px;">
[submit]
</div>
<div style="width: 100%;">* GRBC reserves the right to support our employees and their families. If you do see us present at any of the above events, chances are we're just making a small contribution to a cause or event involving one of our employees or they are choosing to support the cause themselves. Don't take offense.
</div>