Thank you for your interest in participating in the 2020 Seat Belts save challenge! Please fill out this form to sign up get started by telling us more about you for a chance to win $1,500 for your school or organization!

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Thank you to our generous sponsor!

Thank you to our generous sponsor!

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* 1. Teacher/Advisor Contact Information

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* 2. Student Leader #1 Name (If you don't have this information yet, just mark TBD)

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* 3. Student Leader #2 Name (If you don't have this information yet, just mark TBD)

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* 4. Youth Participating Organization (include if this activity will be part of club activities (BPA, DECA, FBLA, FFA, SADD)

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* 5. Anticipated number of student participants

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* 6. When do you plan to have your event?

Date

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* 7. Is your challenge in person or virtual?

T