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!
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