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BoomShake Street Action Requests
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* Indicates required question
Name:
*
Your answer
Organization (if applicable):
Your answer
Event Title:
*
Your answer
Event Date:
*
MM
/
DD
/
YYYY
Event Time:
*
Time
:
AM
PM
Time Range of BoomShake participation:
*
Time
:
AM
PM
Location Name & Complete Address of Event:
*
Your answer
Event Link (website, FB event link, IG post, etc)
Your answer
Email address:
*
Your answer
Day of contact phone number:
*
Your answer
Best way/time to contact you:
*
Your answer
Tell us a bit about yourself/organization:
*
Your answer
What community(ies) is your event for?
*
Your answer
What community(ies) are leading and organizing this event?
*
Your answer
Action Type
*
Rally
March
Community Gathering
Other:
What do you want BoomShake to do at the action?
*
Play a set during a rally
Drum and chant during a march
Other:
How did you hear about us?
*
I saw you at another street action
I saw you perform at an event
Word of mouth
From a friend/another organization (please list whom in the other section)
Website/Social Media (please list which one in the other section)
I'm a present or former BoomShake participant
Other:
Are you/your organization able to make a donation or monetary offering? Either way is fine - it won't affect our decision :)
Yes
No
Maybe, I'll check and let you know
Clear selection
Anything Else? (Questions, Dreams, etc...)
Your answer
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