Arrive Alive High School Registration & Order Form
Please submit this form by 5:00p.m. on March 1 , 2019 to ensure you receive campaign materials on time.
Our school or youth group will take part in the 2019 Arrive Alive Campaign by... *
Name of High School or Youth Group *
Your answer
School or Youth Group Address *
Please include city or town, state, and zip code
Your answer
School or Youth Group Main Telephone Number *
Your answer
Current Student Enrollment *
Your answer
Number of Students in your club or youth group *
Your answer
Adult Sponsor
This should be the individual assisting students with the campaign
Name *
Your answer
Telephone *
Your answer
Email Address *
Your answer
Campaign Materials
How many Survive the Drive Bookmarks would you like? *
How many Prom/Floral Arrive Alive Cards would you like? *
How many "What to do After a Crash" cards would you like? *
How many Arrive Alive Posters would you like? (There are two different designs- we will send you both. If you want 30 posters, we will send you 15 of each design, etc.) *
How many Arrive Alive Pledge Banners would you like? *
How many mini lanyards with a safety message would you like? (Provided by the Allstate Foundation) *
Adult Sponsor Agreement
I agree to abide by the rules of the Arrive Alive campaign and to adhere to all deadlines. *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.