Take Back the Night Participation Form

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Take Back the Night Participation Form

use this form to sign up to speak or perform at our annual Take Back the Night

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Name

Your answer

email contact

Your answer

I would like to speak or perform at the pre march rally

(7 PM)

speak - topics can include empowerment, support, resilience)

perform ( sign, spoken word, dance, instrumental)

I would like to speak or perform at the survivor speak out

(post march around 8 PM)

yes

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