The 84 Chapter Registration/Renewal Form (2014-2015) Question Title * 1. School/Organization Name: Question Title * 2. Name of group (if applicable, e.g. SADD): Question Title * 3. Address (Where you would like to receive materials from The 84): Address City Zip Question Title * 4. Adult advisor's contact information: Name Email Phone, extension Fax Question Title * 5. Youth contacts (They will receive the latest updates from The 84) Youth 1: Name Youth 1: Email Youth 2: Name Youth 2: Email Question Title * 6. Number of youth you EXPECT to be in your 84 Chapter in 2014-2015: Question Title * 7. Please write an updated description (3-5 sentences) about your group. (This will go on your Chapter's page on The 84 website) Click here to see a description on a sample Chapter page. Question Title * 8. How did you hear about The 84 Chapters? I am a returning Chapter The 84 website (The84.org) The 84 staff members Facebook Friends/peers Local Tobacco Control Program Flyer Other (please specify) Question Title * 9. Does your school or organization have a photo release policy already in place? (If you answer "no," you will need to submit a photo release to The 84 staff for everyone involved in your Chapter.) Click to download the photo release form. Yes No Question Title * 10. FOR SCHOOLS ONLY: Did you get approval from your school principal to be an 84 Chapter in 2014-2015? (Approval is required) Yes No Principal's name and email address Question Title * 11. Electronic signature of adult advisor (enter full name as electronic signature): Next