Become a TBTN Member

Become a TBTN Member

TBTN Members sustain the work of TBTN. Membership options are $35 per year, $100 per year, or a Lifetime Membership with a one-time donation of $1000. All Members have access to special events. Membership fees are tax deductible. Please note in completing this form, you understand and agree that TBTN may use your submission and data as part of its aggregate reporting, operations, and internal review. TBTN does not sell your personal data or contact information to any 3rd parties.
Name*

First NameLast Name
Email*

Confirmation Emailexample@example.com
Mobile Phone

Area CodePhone Number
Phone Number (US Country Code = +1; Canada = +1; Australia = +61; UK = +44; find other Country Codes at countrycode.org/)*

Country CodeArea CodePhone Number
Your School, Employer, or Most Closely Affiliated Organization*
Put None if not affiliated.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
I want to be a Member of Take Back The Night because . . . (check all that apply)*

I'm a survivor.I want to support survivors.I want to work to end sexual violence.I enjoy participating in TBTN Events.
How I heard about Take Back The Night . . . (check all that apply)*

Google searchTBTN newsletterTBTN social mediaI have participated in a TBTN eventI have organized a TBTN eventSomeone I know was involved with TBTNSomeone at my institution recommended itOther
I have attended approximately this many TBTN Events:*
Demographics

This information is needed for our non-profit status and other metrics, including those established by grants, governmental agencies, and other NGOs.
I identify as:*

FemaleMaleTransgenderNon-binaryI prefer not to sayOther
My preferred pronouns are:*

She/herHe/himThey/themZe/zemI prefer not to sayOther
I identify as:*

Black or AfricanHispanic or LatinoWhiteAsianAmerican IndianPacific IslanderTwo or more racesUnknownI prefer not to sayOther
I identify as:*

Heterosexual/StraightGay or LesbianBisexualI prefer not to sayOther
My age is:*
Follow us!
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Enter your LinkedIn Account, if you have one:
Enter your Instagram Account, if you have one:
Would you like your name to be listed on the TBTN website as a Supporter/Member?*

YesNo

Individual Membership Fee - Yearly*

TBTN Engaged Membership($35.00 for each year)

Become an Engaged Member for TBTN! Annual fee of $35 as a donation to the Foundation. Renews annually. Can be discontinued at any time. Perks: Get newsletter and automatic access to Global Virtual.

TBTN Involved Membership($100.00 for each year)

Become an Involved Member for TBTN! Annual fee of $100 as a donation to the Foundation. Renews annually. Can be discontinued at any time. Perks: Includes access to 20% discount on TBTN gear, access to TBTN playlist of empowering songs, access to TBTN Event Kit (including poems, survivor stories, and more).

Lifetime Individual Membership($1,000.00 one-time payment)

Become a Lifetime Member for TBTN for a one-time fee of $1000 as a donation to the Foundation. Perks: Includes access to 20% discount on TBTN gear, access to TBTN playlist of empowering songs, access to TBTN Event Kit (including poems, survivor stories, and more).

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