Thank you for participating in the 2019 Seat Belts save challenge! Please fill out this form to get started by telling us more about you and complete the final report by December 16, 2019 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?

Anticipated Date (It's ok if this changes!)

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