Ride Like A Friend (RLAF) Network Registration Form

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Join the RLAF Network. We want your school to conduct the RLAF initiative for one week, between the dates of September 3 and October 30, 2010. Gain access to support materials and webinars that will help you plan a successful campaign in your community.

* required fields.

Date:

First name*:

Last name*:

Organization*:

Office Phone*:

Address Line 1*:

Address Line 2:

City*:

State*:

Zip Code*:

Email Address*:

(Only RLAF-related communications will be emailed to you at this address.)

Please select how you heard about the RLAF campaign. (check all that apply)*

If other, please describe:

Please select a work description and job title.*

If other, please describe:

RLAF Campaign Interest*

I am interested in conducting 2010 RLAF initiative during one of these weeks:

During National Teen Driver Safety Week (NTDSW)

October 17, 2010 - October 23, 2010

Before NTDSW --

September 26, 2010 - October 2, 2010
October 3, 2010 - October 9, 2010
October 10, 2010 - October 16, 2010

After NTDSW --

October 24, 2010 - October 30, 2010

I am interested in conducting the week-long RLAF initiative in 2010, but not during the above specified weeks.

I may conduct the 2010 RLAF initiative and might use the activities/materials in 2010 as part of a classroom activity and/or other school based activities.

Type of School

I plan to work with (select all that apply):

I plan to work with the following Schools - include name and website address (List up to 12 schools):

Ride Like A Friend (RLAF) Network Registration Form

RLAF Campaign Interest*

Type of School

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