Awareness Presentation Registration
* Required
Which Awareness Campaign(s) are you registering for?
*
Classroom Presentation
Youth Group Presentation
General Youth Awareness Presentation
Community Event
Training (Professionals or Parents)
Other:
Required
Personal Information
Name (first & last)
*
Your answer
Title/Position
Your answer
Grade (if student or teacher)
Your answer
Email
*
Your answer
Phone Number (please put the number that is easiest to contact you)
*
Your answer
How do you prefer being contacted?
*
Email
Call
Text
How are you registering?
*
Individual
Organization [school/church/business/etc.]
Other:
Are you requesting this to be an in-person presentation or a virtual presentation?
*
In-person
Virtual (i.e. Zoom or other web conferencing platform)
Both
Other:
Organization/School Info
If this is a virtual presentation, disregard questions pertaining to a physical location.
Name
*
Your answer
Address (Street, City, State, Zip Code)
*
Your answer
Website
*
Your answer
Phone
Your answer
Event Details
Requested date(s) for campaign:
*
(mm/dd/yy)
Your answer
Requested time for campaign:
*
specific time (ex: 11:30am-12:45pm), half-day (morning), half-day (evening), full-day, etc.
Your answer
Suggested arrival time:
If applicable for set up, technology run through, sound check, etc.
Your answer
Is the presentation location the same as the address given above?
*
Yes
No
If not, please provide the address (street, city, state, zip code) of the presentation location.
Your answer
Additional location details:
If applicable: building number/name, room number, parking instructions, etc.
Your answer
Estimated length of presentation:
*
Your answer
How many presentations are being requested?
*
1
2
3
4
Other:
Estimated number of people in attendance
*
Your answer
Will there be proper equipment for presentation media? (i.e. overhead projector, computer, speakers, access to digital platform, etc.)
*
Yes
No
If so, please select the equipment that will be provided:
Projector
Screen
Speakers
Microphone
Zoom or other web conferencing platform
Other:
Brief description of requested event:
*
Your answer
Additional comments:
If your request is for an in-person presentation, please include as many details as possible about social distancing and other health policies your venue/agencies is implementing.
Your answer
Thank you for booking with us! We are excited to fight for freedom with you! We will contact you within a week of your submission to confirm your registration and begin the planning process!
Welcome to the Rebellion!
Submit
Never submit passwords through Google Forms.
This form was created inside of Red Light Rebellion.
Report Abuse
Forms