Arrive Alive Registration & Order Form for Middle Schools
Please submit this form by 5:00p.m. on March 3, 2017 to ensure you receive campaign materials on time.
Our school will take part in the 2017 Arrive Alive Campaign by... *
Name of Middle School *
Your answer
School Address *
Please include city or town, state, and zip code
Your answer
School Telephone Number *
Your answer
Current School Enrollment *
Your answer
Number of Students in Your Club *
Your answer
School Resource Officer/ Sponsor
This should be the individual assisting students with the campaign
Name *
Your answer
Telephone *
Your answer
Email *
Your answer
Campaign Materials
How many Arrive Alive posters would you like? *
How many Passenger/Bike/Pedestrian Tip Cards would you like? *
How many Arrive Alive Pledge Banners would you like? *
How many "Make Safety A Point" Pencils would you like? *
(Provided by Mid-Atlantic Foundation for Safety and Education)
How many Sunglasses would you like? *
(Provided by the Allstate Foundation)
Campaign Sponsor Agreement
I agree to abide by the rules of the Arrive Alive campaign and to adhere to all deadlines. *
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