Apply to be a TBTN Point of Light

Apply to be one of the TBTN 10 Points of Light

Thank you for your interest in becoming one of the 10 Points of Light for Take Back The Night Foundation! Please complete the application and participation agreement below. We will notify you within 1-5 business days if you have been selected.
Full Name*

First NameLast Name
What is your title or position?*
What is the name of your organization or group?*
What is the name of your most closely affiliated school, college, university, company or other organization? (If it is the same as the group listed above, please type "Same as above.")*
Email*

Confirmation Emailexample@example.com
Cell Phone*

Country CodeArea CodePhone Number
Office Phone*

Country CodeArea CodePhone Number
Shipping Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Secondary Contact Person*

First NameLast Name
Secondary Person Email*

Confirmation Emailexample@example.com
Secondary Contact Cell Phone*

Country CodeArea CodePhone Number
Please provide a description of what your group would be doing on the event day to show your support for survivors of sexual violence:*
Please upload a logo or other image for your organization.*

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Please provide your group's social media handles for Twitter, Facebook, Instagram and any other platforms you use:*
We are applying to be one of the 10 Points of Light for April of what year?*
Terms and Conditions for being one of the 10 Points of Light (10 POL)

Please review and indicate your acceptance of the following terms by signing below.

I agree to host an event that clearly reflects the mission of the Take Back The Night Foundation and shows support to survivors during the month of April for the event year.

I agree to designate a coordinator and co-coordinator who will be in communication with the Take Back The Night Foundation regarding our event.

I agree to submit an event itinerary to TBTNF at least 2 months before the event for publication by the Foundation. I understand that I may make minor modifications to this itinerary up until one week before the event.

On behalf of my organization and institution, I WAIVE, RELEASE, AND DISCHARGE the Take Back The Night Foundation from any and all liability, including but not limited to, liability arising from the negligence or fault of the Take Back The Night Foundation, event attendees and/or sponsors, for any death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to myself or event participants or volunteers as part of my entity's involvement in 10 POL.

I understand any costs or expenses related to our 10 POL Event are the sole responsibility of our organization or institution and I will in no way hold the Take Back The Night Foundation responsible for any incurred expenses.

I understand that if I hold a fundraiser as part of my 10 POL Event, the funds raised will be given entirely to the Take Back The Night Foundation as a charitable donation.

I agree to the TBTN Trademark Usage Terms and Conditions listed on the Take Back The Night Foundation website as part of my participation in the 10 POL Event.

I agree to have my entity's logo displayed on TakeBackTheNight.org with a short description of our event. I permit the 10 POL Organizer to hyperlink my logo to my organization's webpage if we have one. I understand that my organization’s name and 10 POL Event information may be included in marketing or other information about the 10 POL event by the Take Back The Night Foundation.

I have the authority to sign this agreement on behalf of my organization or institution and have received the appropriate approvals from my organization or institution to do so; and I am a legal adult of at least 18 years of age.

In signing this form submission, I hereby agree to these Participation Terms and Conditions.
Are you of legal consenting age or acting with permission of a parent or legal guardian?*

I am at least 18 years of age, and am acting in my capacity as a legal adult in signing and agreeing to the terms of these terms and conditions.I am less than 18 years of age, and as a minor have the permission of a parent or legal guardian to sign and agree to the terms of these terms and conditions.
Please read the terms and conditions above and respond below:*

I hereby agree to the Terms and Conditions for being one of the 10 Points of Light.
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Apply to be one of the TBTN 10 Points of Light