*1.Please provide us with your contact information.(Required.)

Name *

Organization *

City/Town

State/Province *

Email Address *

Phone Number

2.What other social movements or sectors have you involved in this work?

3.What is one idea you have for moving people to action?

4.How have the cultural events of recent years impacted the way you communicate about your work to prevent sexual and intimate partner violence?

5.Which strategy or strategies fit most closely with the work you described above? Please select all that apply.

Promoting social norms that protect against violence

Teaching skills to prevent violence

Providing opportunities to empower and support women and girls

Creating protective environments

Strengthening economic supports

Engaging influential adults and peers

Disrupting developmental pathways toward partner violence

Interrupting oppression and connecting to other social justice movements

Other (please specify)

6.Are you available on October 29, 2019 at 11 am Pacific / 2 pm Eastern

YesNo