Skip to content

PTM Foundation Land Acknowledgement Partner Form

Please fill in your information below and someone from our team will be in touch!
1.What is your first name?(Required.)
2.What is your last name?(Required.)
3.What is your phone number?(Required.)
4.What is your email address? (Primary Contact)(Required.)
5.What is the name of your organization? (Required.)
6.What is your organization or Tribe's mailing address?(Required.)
7.What is your Tribal affiliation? (Please list all that apply)(Required.)
8.What is your official website? (If there are multiple sites, please include all)
9.Please list any additional email addresses you would like copied on communications about partnering with PTM Foundation
10.Please include a short blurb about your organization and/or Tribe's mission and work (1-3 sentences)(Required.)
11.Please upload your organization or Tribe's logo in hi-resolution
No file chosen
12.Please upload a hi-resolution photograph we can use to promote your organization or Tribe on social media 
No file chosen
In order to comply with various national, state and/or local laws, or venue regulations, we ask the following questions regarding COVID-19.

“Fully vaccinated" means that (a) you have received the second dose of a two-dose COVID-19 vaccine (Pfizer or Moderna) or after receiving the single-dose COVID-19 vaccine (Johnson & Johnson) and (b) if it is more than five (5) months after you received the second dose or single-dose referenced above, you have received a booster shot.
13.Are you fully vaccinated? If yes, please provide dates of vaccinations.(Required.)
14.Prior to the Land Acknowledgement, will you be able to provide proof of vaccination either with a copy of your vaccination card or through a state or federal application or website offering proof of vaccination?(Required.)
15.If necessary, would you be able to submit proof of a negative COVID-19 test prior to the Land Acknowledgement?(Required.)
Current Progress,
0 of 15 answered