Rise Up and Speak Out Event Registration Form
Last Registration Day - August 1 2025
Attendee Information
Please fill name and contact information of attendees.
Company/Organization Name
Organization Supports or Services provided to the community above
Title
Email Address
*
example@example.com
Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Will you have a guest with you?
Yes
No
Guest Name
Mr.
Mrs.
Miss.
Prefix
First Name
Last Name
Email Address
example@example.com
Contact Number
Please enter a valid phone number.
Format: (000) 000-0000.
Event Information - Multiple Cities
Join us for Rise Up and Speak Out: A Community Day on August 30, 2025 — a powerful youth empowerment and anti-bullying event hosted by the Earn Your Wings Book and Speakers Tour. This community gathering will feature inspiring performances, youth-led advocacy, mental health resources, creative expression zones, and tools for a safe, successful school year. Open to youth ages 13–23, families, and community members.Let’s rise, heal, and lead—together.
Event Date interested in:
*
August 30- Charlotte NC, Brookwood Inn
August 30- Houston TX, TBD
August 24- Washington DC area, Oxon Run Park
August 30- Columbia SC, Hyatt Park
All participants must register here first https://riseupspeakout2025.eventbrite.com
*
Completed
Will complete within 8 hours or my registration is void
You are interested in:
*
Resource only vendor ($donation)
Retail Vendor ($30)
Venue Sponsor
Media Partner
Community Based Organization
School
Church
Mental Health Organization/Therapist
Police Department
Featured Speaker (3 available each City - $donation)
Volunteer (5 needed in each city)
Food Donations (hot dogs, buns, water, etc)
Music Artist, Poet or Visual Artist ($donation)
Youth Organization/Program ($donation)
Current EYW Team Partner
Other
If you answered Other above, please provide details. We are open to your ideas to make this a successful event.
What City is closest to you:
*
Charlotte NC
Houston TX
Washington DC
Norfolk VA
Columbia SC
Baton Rouge LA
None of the above
If you answered None of the Above, please list your City and State only.
Are you interested in becoming an official Partner or Sponsor to Tour to all States or raise awareness about your advocacy in multiple States?!
*
Yes I'm interested
No thank you
Type option 3
Type option 4
Vendors and Organizations please upload your logo to include on the partner banner in PNG format only. Logos can also be emailed to safehavenyouthadvocates@gmail.com subject YOUR ORGANIZATION NAME
Browse Files
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of
Interested speakers please upload a professional headshot and your bio or EPK.
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All participants in this event must arrive no later than 30 minutes before the event starts. Please acknowledge you understand this requirement.
*
Yes I understand.
All vendors are required to bring their own tables and chairs for set up to event no more than 6ft long and no more than two chairs. Please acknowledge you understand this requirement.
*
Yes I understand.
Not applicable.
All participants registered must promote the event on their social media and websites. Please acknowledge this requirement.
*
Yes I understand.
No. I do not have social media/website.
If for any reason, you are no longer to commit to participating in the event, you we ask that you make every attempt to notify the organizer at safehavenyouthadvocates@gmail.com.
*
Yes I understand.
Emergency Contact Day of Event
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Would you like to be updated about upcoming events on the Earn Your Wings Book and Speakers Tour and the new Safe Haven Youth Advocates Pilot?
*
Yes to the Tour!
Yes to learning more about Safe Haven Youth Advocates
Yes to both!
Not interested
Thank you for your support and participation in the Rise Up and Speak Out Community Day!
For questions, concerns please email safehavenyouthadvocates@gmail.com. - BVP Project Safe Haven Board
Submit
Your Name
*
Mr.
Mrs.
Miss.
Prefix
First Name
Last Name
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