Classroom Presentation Registration
Registration Form for new schools.
Which classroom presentation 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
School Info
Name *
Your answer
Address (Street, City, State, Zip Code) *
Your answer
Website
Your answer
Bell Schedule
The start and end time of each class period for your grade level and/or school.
Your answer
Presentation Details
Note that presenters will arrive 30 minutes prior to the start of the 1st class for set up.
The class subject receiving the presentations: *
(Ex: health, history, language arts, media, criminal justice, etc.)
Your answer
Requested date(s) for presentation(s): *
(mm/dd/yy)
Your answer
Class periods that will receive the presentations: *
specific time (ex: 1st-7th period with 3rd hour prep & 5th hour lunch)
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:
Building number/name, room number, parking instructions, sign-in instructions, etc.
Your answer
Are there any known alternative schedules during presentation days? *
This can include: study hall days, assembly schedule, half days, fire alarms, lock down drills, etc.
If yes, please provide the dates and alternative schedule:
Your answer
How many students will there be during each class period? *
Your answer
Will an overhead projector & screen be available? *
We will provide our own computer and speaker set up.
Additional comments:
Your answer
Thank you for registering for a classroom presentation! 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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