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* 1. School/Organization Name:

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* 2. Chapter Name:

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* 3. Today's Date: 

Date

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* 6. Federal Tax ID (FEIN) Organization exactly how it is listed on your organization’s form

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* 7. Federal Tax ID (FEIN) Number

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* 8. How did you hear about The 84?

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* 9. Address (Where you can receive materials from The 84)

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* 10. Adult Advisor #1 Name

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* 11. Adult Advisor #2

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* 12. Youth Leader Contact Information 

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* 13. Number of youth expected in your chapter:

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* 14. Please write and updated description (3-5 sentences) about your group. (This will go on your Chapter's page on The 84 website)

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* 15. If your Chapter has any social media platforms (i.e. Twitter, Facebook, Instagram) please list your handles so we can connect with you. 

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* 16. Does your school/organization have a photo release policy? (If you answer, "no", you will need to submit a photo release to The 84 staff for everyone involved in your Chapter.

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* 17. FOR SCHOOLS ONLY: Did you get approval from your school principal to be an 84 Chapter in 2029-2021?

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* 18. Electronic signature of adult advisor (enter full name as electronic signature)

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