Buckle Up Phone Down: Accept the Challenge as an Individual

Buckle Up Phone Down: Accept the Challenge as an Individual
If you want to pledge as part of the High School Showdown, please do using the form at this link: https://www.savemolives.com/mcrs/AAAShowdown
Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Would you like a FREE Buckle Up Phone Down Window Cling?*

Yes, Please mail me one to the address listed above.No Thanks, I do not want a window cling.
Employer
School
E-mail*
example@example.com
How did you hear about Buckle Up Phone Down?*
Take the Buckle Up Phone Down challenge and post your photo on Facebook with your right thumb up and your left thumb down using this BUPD Facebook frame:

www.facebook.com/fbcameraeffects/tryit/376200479586998/
Should be Empty: