GENTX WEEK AMBASSADOR SIGN-UP FORM
Join GenTX Week as an Official Ambassador during November 18-22, 2013 and receive special recognition and prizes for your role. As an Ambassador, you'll get entered into exclusive ambassador contests and PRIZE drawings. You'll be be scored for how you rev up your community for the three Take the Challenge contests, including the $1,500 scholarship video contest.
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Ambassador winners to be announced both Friday, Nov. 22 and Friday, Dec. 6.
No cost to sign up. Please fill out all fields below.
First Name *
Last Name *
Address *
Address 2
City *
State *
Zip Code *
Primary Phone *
Alternative Phone or Cell Phone
Email *
Are you a high school student? *
What is your t-shirt size? *
FOR STUDENTS ONLY
High school students should fill out the following questions. Please write N/A if not applicable.
Parent/Guardian's First Name *
Parent/Guardian's Last Name *
Parent/Guardian's Phone *
Parent/Guardian's Email *
Name of High School *
School District *
High School Address *
City *
State *
Zip Code *
Have you ever worked on a Generation TX project before? *
What extracurricular activities do you participate in? (check all that apply) *
Required
Provide detail of your extracurricular activities.
What are your hobbies and interests?
FOR ORGANIZATION REPRESENTATIVES
Please fill out the following questions if you are a representative with an organization or nonprofit. Please write N/A if not applicable.
Organization
First Name of Primary Contact
Last Name of Primary Contact
Email Address of Primary Contact
Phone Number of Primary Contact
Title
Approximately how many high school students in your region do you serve?
Has your organization ever worked on a Generation TX project before?
Clear selection
THANK YOU FOR YOUR INTEREST IN GENERATION TX!
Please click the submit button to apply to become a 2013 GenTX Week Take the Challenge Ambassador.
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