Section 1 of 1
Resistance Party-in-a-Box Registration
Please fill out the form below to nominate a group to receive a box or to request a box for your own group.
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Name
Name
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Time
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Contact Phone Number
Contact Phone Number
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Contact Email
Contact Email
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Address to receive box
Address to receive box
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Group Type
Group Type
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Date
Time
Book Club
Athletic Group
Social Group/Meet-Up Group
Friend Group
Resistance Group
Political Group
Other
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add "Other"
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Describe your group
Describe your group
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Approximate number of attendees
Approximate number of attendees
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Date
Time
2-5
5-10
10-15
15-20
>20
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or
add "Other"
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When do you want to receive a box?
When do you want to receive a box?
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Nominated by
Nominated by
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Other comments
Other comments
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Time
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