2017 E-Communications Request Form

What e-communications template/s do you need?

E-Blast E-Newsletter Both

Do you have a MailChimp account for your department?

YES NO

What is your MailChimp Login Name?

Please enter your MailChimp User Name and Password

Name of current MailChimp Account Owner:

Enter First and Last Name

E-mail Address of current MailChimp Account Owner:

Who should be the owner for this new MailChimp Account?

Enter the person's Name and E-mail Address

Are there other users who need access to this account?

YES NO

List of other user/s for this account:

Do you need MailChimp Training?

YES NO

What are the dates you have available for training?

Which type of training do you prefer?

By Phone In Person No Preference

Please enter your office location:

What is the best number to reach you?

When do you need this done by?

MailChimp Acknowledgement

YES, I have read the terms of MailChimp's free account set-up

By checking this box, you are confirming that you have read the terms of MailChimp’s free account set-up.