Giant Inflatable Colon Request

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Are you hosting a colon cancer awareness event or health fair and a giant inflatable colon from the Colon Cancer Coalition could help educate your attendees about the importance of screening for colorectal cancer? Please confirm you can provide the information below and complete the form. A member of our team will follow-up with confirmation and all the details. 1. Provide proof of liability insurance. 2. Donation of $2,000 + processing fees. This cost includes covering shipping (FedEx Ground), staff time, and wear-and-tear to the colon. Payment must be received prior to the colon being shipped to your location. 3. The colon must be shipped to a business address with ability to receive the colon between 8 a.m. and 5 p.m. weekdays. 4. Confirm you can return the colon within 2 business days of the event (Colon Cancer Coalition can provide shipping label). 5. Upon availability only. Please provide as much lead time as possible for your event request, but we need a minimum of six weeks between request date and event event date.
Name*
MM slash DD slash YYYY
MM slash DD slash YYYY
Include name, email, and phone number for this individual.
Can you provide certificate of insurance with a $1 million general liability insurance with Colon Cancer Coalition listed as an additional insured.
Or email insurance certificate to info@coloncancercoalition.org
Max. file size: 300 MB.
Can you provide a donation of $2,000 plus processing fees to cover shipping, staff time, and wear-and-tear to the colon? Online payment is available via ACH or credit card. Secure payment link to be provided when the request is approved.*
Do you have a business address with ability to receive the colon between 8-5 p.m. weekday?*
Include the name for the shipping label and phone number.
Can you ship the colon to a provided address within 2 business days of the event (Colon Cancer Coalition will provide shipping label)?*
CARE AND USAGE - PLEASE CONFIRM YOUR VENUE CAN ACCOMMODATE THE FOLLOWING:*
• Colon comes in a hard plastic shipping container - approximately 21" deep x 26" wide x 37" long • Inflated size - 12’ tall, 12’ wide, 10’ long • Shipping Weight - approximately 100 lbs • Colon weight - 85 lbs • Setup requirements - access to a three-pronged electrical outlet, a footprint of approximately 20'x20' will allow 3-5 feet around all sides. (indoor/outdoor three-pronged extension cord included). • Motor/power requirements - Self-contained built-in blower needs normal wall outlet or a generator with a minimum of 3500 watts. • If used over multiple days, the colon must not be left inflated overnight.• Indoor use - minimum ceiling height of 15'. • Outdoor use - the provided tethers must be used outdoors either with sandbags or stakes (not provided). The colon may not be used outdoors where winds are 25mph or more and must be deflated and stored in rain. • The colon, storage bag, and shipping container must be dry before being packed up for return shipping.
Please confirm you and your team will not alter or change the signage included on the colon, including covering or altering informational signage, logos, placements, etc. Depending on the colon schedule and shipping logistics, additional items specifically for Colon Cancer Coalition events may also be in the shipping container. These items MUST remain in the shipping container and be sent along with the colon to the next stop on The Great Colon Tour.*
Please confirm you understand this is a request form only. Our team will process this request and will check the availability and logistics involved and get back to you with confirmation within one week.*
By submitting this application, and checking this box, I agree that all the information provided here is accurate, and if the colon is available for my event, I will notify the Colon Cancer Coalition immediately should any of these details change. I agree to notify the Colon Cancer Coalition of any harm or damage that occurs to the colon while it is under my care. I will not hold the Colon Cancer Coalition liable for any damage to person or property from use of this inflatable educational tool that occurs while the colon is in my possession.*