YOUR LIFE COUNTS! - Empowering and helping teens make healthy life choices

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PLEASE NOTE THIS IS NOT A CONTRACT OR AN ACCEPTANCE OF AN INVITATION TO COME TO YOUR COMMUNITY.
GENERAL INFORMATION:
Choose a Speaker:
Has a team member appeared for your organization before?
If yes, please give ALL prior dates.
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PROPOSED EVENT:
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If scheduling with other schools in your area, travel time between schools cannot be more than 45 minutes. Please check all that apply.
School Assemblies	Music Festival
Fundraising Banquet	Peer Mentoring
Youth Conference	Parent/Teacher Training
Adult Conference	Drama Training
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Any other comments would be appreciated and will help us evaluate your request. Please give us as much information as possible to help us understand your event, especially regarding any evening event. What is the purpose, who is the audience, what are you wanting to accomplish and what is your VISION?
Thank you for submitting your request. We will review the information you’ve provided and will contact you within 3-4 business days. If you do not receive a response within 5 business days please call our offices at 1-866-665-5YLC (592) to ensure receipt of your request. We look forward to partnering with you to bring YOUR LIFE COUNTS! to your community.

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