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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