Employer Registration

After submitting the form below, you will receive an e-mail confirmation that includes the information you provided, along with a request for your logo so we can include it in Give Back Iowa Challenge promotional messages.

Employer Information

Employer Name

If employer has multiple sites participating in the challenge, please register each one separately and include the location as part of the name (e.g. 123 Construction-Des Moines or ABC Insurance-Anamosa).

Type of Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Number of Employees

Who will be logging hours for the Employer?

Would you like your company to be included in any upcoming publicity?

Point of Contact for Challenge

Name

Title

Phone