Submit a Reward

Please complete one form for each location where a reward may be redeemed in order for it to show up correctly on the DFCA mobile app and website.

Company*
Contact Name*
First Last
Email*
Contact Title*
Address*
Street Address Address Line 2 City State ZIP Code
The following “Community Reward” offer(s) may be made through DFCA to its members as our way of helping teens continue to make the right choice:*
Members may redeem this offer by:*
- Simply showing Valid photo ID Club Card - Issued by DFCA at time of membership
- Presenting a printed coupon or voucher with Valid Club Card (vouchers must be produced by business and sent to applicable school)
Additional Notes, Details, or Restrictions:
By signing below, I confirm that:

1. I have the authority to present this offer as detailed on this agreement

2. I am not relying upon any promise, or representation of return other than as previously stated.

3. The above reward offer will remain in place until a written request is made, upon which time any parties involved will comply with the request within two calendar weeks.

Authorization: Type your First and Last Name as Listed Above in the box below to confirm.
Authorizing Person Name*
First Last