Resource Partner Registration
Share your organization details and the trauma-related resources you’ll provide for the book launch community event.
Contact Information
Organization/Business Name
*
Primary Contact Name
*
Title/Position
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Website URL
Social Media Handles
Tell Us About Your Resources
Brief description of your organization and mission
*
Trauma-related resources, programs, or services provided
*
Primary audience
*
Children
Teens
Adults
Women
Men
Families
Parents/Caregivers
Survivors of Childhood Abuse
Survivors of Sexual Abuse
Survivors of Domestic Violence
Trauma Survivors
Faith Communities
Mental Health Professionals
Other
Types of resources shared at the event
*
Educational Information
Counseling/Therapy Resources
Support Groups
Crisis Resources
Survivor Support
Family/Parent Resources
Faith-Based Support
Books/Publications
Community Programs
Referral Services
Brochures/Handouts
Other
Service pricing model
*
Free
Fee-Based
Both Free and Fee-Based Services
Insurance Accepted
Varies by Program
Additional notes attendees should know about your services
Event Setup
Number of Representatives Attending
*
Number of Chairs Needed
*
Please Select
1
2
3
Other
Table Needed
*
Yes — Please provide one table
No — We do not need a table
Access to Electricity Required?
*
Yes
No
Special Setup or Accessibility Needs
Logo & Organization Materials
Upload your organization logo
*
Upload a File
Drag and drop files here
Choose a file
Cancel
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Would you like us to tag your organization in event-related social media?
*
Yes
No
Exact social media handle(s) to use
Participation Agreement
Acknowledgments and Consent
*
I understand setup begins at 4:30 PM on September 26, 2026
I understand the event runs from 6:00 PM to 10:00 PM
I understand the event is connected to Denise Benz's Only My Face Was Smiling
I understand submission does not guarantee participation and approved partners will be confirmed
I grant permission to use our submitted organization logo for event-related promotional and recognition purposes
Name of Person Completing Form
*
Electronic Signature
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Submit
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