* 1. School/Organization Name:

* 2. Name of group (if applicable, e.g. SADD):

* 3. Address (Where you would like to receive materials from The 84):

* 4. Adult advisor's contact information:

* 5. Youth contacts (They will receive the latest updates from The 84)

* 6. Number of youth you EXPECT to be in your 84 Chapter in 2015-2016:

* 7. Please write an updated description (3-5 sentences) about your group. (This will go on your Chapter's page on The 84 website) Click here to see a description on a sample Chapter page.

* 8. How did you hear about The 84 Movement?

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

* 10. Does your school or organization have a photo release policy already in place? (If you answer "no," you will need to submit a photo release to The 84 staff for everyone involved in your Chapter.) Click to download the photo release form.

* 11. FOR SCHOOLS ONLY: Did you get approval from your school principal to be an 84 Chapter in 2015-2016? (Approval is required)

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

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