The 84 Chapter Registration and Renewal Form Question Title * 1. School/Organization Name: Question Title * 2. Chapter Name: Question Title * 3. Today's Date: Date / Time Date Question Title * 4. School or Community Organization School Community Organization Question Title * 5. Are you a High School or Middle School? High School Middle School Middle High School Question Title * 6. Federal Tax ID (FEIN) Organization exactly how it is listed on your organization’s form Question Title * 7. Federal Tax ID (FEIN) Number Question Title * 8. How did you hear about The 84? Returning Chapter The 84 website The 84 Staff Member Cold Call Social Media Friends/Peers Local Tobacco Control Program Flyer Other Question Title * 9. Address (Where you can receive materials from The 84) Question Title * 10. Adult Advisor #1 Name First and Last Name School/Organization Email Address Phone Number Question Title * 11. Adult Advisor #2 First and Last Name School/Organization Email Address Phone Number Question Title * 12. Youth Leader Contact Information Youth Leader #1 Name Email Address Question Title * 13. Number of youth expected in your Chapter: Question Title * 14. Please tell us just a little about your group. (1-3 sentences is fine). Question Title * 15. If your Chapter has any social media platforms (i.e. Twitter, Facebook, Instagram) please list your handles so we can connect with you. Question Title * 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. Yes No Question Title * 17. FOR SCHOOLS ONLY: Did you get approval from your school principal to be an 84 Chapter this school year? Yes No Question Title * 18. Electronic signature of adult advisor (enter full name as electronic signature) Done