GA First 2000 Days Champion Agreement
Please complete this form to commit to serving as a First 2000 Days Champion in Georgia. Champions play key roles in community outreach. They are trained to give the First 2000 Days presentation, suggest opportunities to give presentations and are presenters themselves. These community influencers carry the First 2000 Days message with them in their professional and personal life.


Please contact Vett Vandiver at GEEARS with any questions (vvandiver@geears.org)

First and Last Name *
Your answer
Email Address *
Your answer
Mailing Address (where your toolkit will be shipped) *
Your answer
Phone Number *
Your answer
Title and Organization/Company
Your answer
Professional or Volunteer Organization Affiliations *
Your answer
How did you hear about the campaign? *
Your answer
I believe the first 2,000 days of a child's life are important because... (short paragraph response) *
Your answer
I am committed to participating as a Champion in the following ways: (check the items your organization can commit to) *
Required
Age Range *
County of Residence *
Your answer
City of Residence *
Your answer
Please submit a professional photo that may be shared in First 2000 Days promotional materials to Vett Vandiver at vvandiver@geears.org *
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