Awareness Presentation Registration
Which Awareness Campaign(s) are you registering for? *
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? *
How are you registering? *
Organization/School Info
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? *
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? *
Estimated number of people in attendance *
Your answer
Will there be proper equipment for presentation media? (i.e. overhead projector, computer, speakers, etc.) *
If so, please select the equipment that will be provided:
Brief description of requested event: *
Your answer
Additional comments:
Your answer
Thank you for registering for an Awareness Campaign! 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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