Arrive Alive High School Registration & Order Form

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To receive materials prior to the campaign start date, complete this form by 5:00 PM on February 17, 2023. Schools and youth groups may register at any time; however, materials are available on a first come, first served basis.

Our school or youth group will take part in the 2023 Arrive Alive Campaign by... *

Please note: If you are unsure which level of participation is best for your students, you can always notify us during the campaign to change your selection. Likewise, you won't be penalized if you elect to compete and do not complete all of the components. We're so glad you're participating! :)

Competing for campaign prizes.

Participating without competing for campaign prizes.

Name of High School or Youth Group: *

Address: *

Please include city or town, state, and zip code

Phone Number: *

Adult Sponsor

This should be the individual assisting students with the campaign.

Name: *

Phone Number: *

Email Address: *

Current Student Enrollment for the School (if applicable): *

Number of Students in your club or youth group: *

Number of Male Members in your club or youth group: *

Number of Female Members in your club or youth group: *

Campaign Materials

How many Slow Down. Buckle Up. No Distractions. Cards would you like? *

100

200

How many "What to do After a Crash" cards would you like? *

100

200

How many Arrive Alive activity books would you like? *

100

200

How many "Arrive Alive - It's a Whole Vibe" pledge banners would you like? *

How many custom pin-back buttons with a safety message would you like? *

(Funded by State Farm)

These are fun to pin on backpacks, hats, shirts, etc.

100

How many "Arrive Alive - It's a Whole Vibe" wristbands would you like? *

(Funded by State Farm)

100

How many "Stop the Excuses. Slow Down. Buckle Up. No Distractions" posters would you like? *

*Please note: these posters are from the 2022 Arrive Alive Campaign

Campaign Sponsor Agreement:

I agree to abide by the rules of the Arrive Alive campaign and submit the final campaign evaluation. *

Yes

Submit

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