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| Your Name | |
| Age | |
| Street Address | |
| City | |
| State/Province | |
| Zip/Postal Code | |
| Country | |
| Work Phone | |
| Home Phone | |
| Cell Phone | |
| FAX | |
| Website |
| Your School | |
| Your Grade | |
|
Your Principal's Name |
Does your school currently have a Students Against Drunk
Driving group that meets?
Yes
No
Don't Know
Are You Interested In Donating Your Time?
Please
select any of the following areas in which you would like to help:
Promo Items ("Think Before You Drink" bumper stickers, etc.)Volunteer to speak
Volunteer to pass out literature
Volunteer to help set-up/take down displays
Volunteer to organize local group
Other If other, what?Are you interested in donating your services?
The "Think Before You Drink" campaign is not accepting any financial donations, only donations of time and labor. Our needs are as follows. If you have the ability to provide any of the following needs, please place a mark next to the need and someone will be in touch with you:Printing services (for "Think Before You Drink" literature)
How has drinking and driving affected you?
If you have been directly affected by drinking and
driving, and you would like to share your story with others, we are looking for
volunteers who would be willing to go into schools to speak to kids. If
you would like to volunteer to speak kids, please take a moment to share with us
how drinking and driving has affected you (this
information will held confidential):
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