Girl Talk Club Application
Club Name
*
Phone Number (If virtual, use personal phone #)
*
Will your club be a part of a currently active program within a for-profit or non-profit organization?
*
Yes
No
Club Meeting Location (If meeting virtually, please put "Virtually')
*
Type of Facility
*
School, Home, Virtually, etc.
Full Mailing Address (If virtual, use home address please)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Leader Information
Leader's Name
*
First Name
Last Name
Gender
*
Race/Ethnicity
*
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or other Pacific Islander
White
Multiracial
Prefer not to answer
Other
Leader's Email (must be different than Advisor's email)
*
Would you like to receive email alerts about new Girl Talk podcasts?
*
Yes
No
Leader's Phone #
*
Is the above phone # work, home, or cell?
*
Work
Home
Cell
Would you like to be added to our texting program + receive inspirational texts from Girl Talk?
*
Yes
No
Leader's Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Leader's Birth Month + Day
*
June 5th, December 31st, etc.
How did you first hear about Girl Talk, Inc.?
*
Leader School Information
Leader's Graduation Year
*
Name of School
*
School Phone #
*
School Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Leader Parent/Guardian Information
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Email
*
Parent/Guardian Phone #
*
Advisor Information
Must be 18+ years old + not currently attending high school
Advisor's Name
*
First Name
Last Name
Advisor's Role
*
Parent, Teacher, College Student, etc.
Gender
*
Race/Ethnicity
*
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or other Pacific Islander
White
Multiracial
Prefer not to answer
Other
Advisor Email
*
Would you like to receive email alerts about new Girl Talk podcasts?
*
Yes
No
Advisor Phone #
*
Is the above phone # work, home, or cell?
*
Work
Home
Cell
Would you like to be added to our texting program + receive daily inspirational texts from Girl Talk?
*
Yes
No
Advisor Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Advisor's Birth Month + Day
*
June 5th, December 31st, etc.
How did you first hear about Girl Talk, Inc.?
*
Advisor Signature
*
Thank you very much for completing our Girl Talk Club Application- please click submit to ensure we receive your answers!
Submit
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