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Public Service Announcement (PSA) Registration

Complete the following questions to enter the contest as an individual or group.  Each PSA should promote an anti-violence message and be consistent with the purpose of National Youth Violence Prevention Week.  Submissions which do not meet this criteria will not be considered.

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* 1. Are you entering the contest as an individual or group?

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* 2. If entering as an individual, what is your first name?

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* 3. What is your last name?

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* 4. If entering as a group, what is the group's name?

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* 5. If participating as a group, how many people are in the group?

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* 6. Enter the first and last name of each participant in the group.

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* 7. What school do you attend? If participating as a group, please check all that apply.

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* 8. What will be the format of your PSA presentation?

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* 9. What is the first and last name of the primary contact for this registration?

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* 10. Telephone Number:

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* 11. Email Address:

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