IF YOU HAVE MORE THAN ONE EVENT TO REGISTER, PLEASE CLICK HERE.

On October 16, 2008, thousands of afterschool programs in communities nationwide will celebrate Lights On Afterschool! Be a part of this effort to showcase the importance of afterschool programs and underscore the need for quality afterschool programs for all children.

NOTE: Your program and contact information will be listed on this site's "Find a Lights On! Event" page.

* Indicates required fields. Please leave blank any non-required fileds for which you do not have and/or wish to provide an answer

Name:
Prefix: Dr. Ms. Mr. Mrs. Rev. Sister First*: M.I.: Last*:
Suffix: II III Jr. Sr.
Title:
E-mail*:
Phone*: use form xxx-xxx-xxxx
Ext.:
Fax: use form xxx-xxx-xxxx

Program/Organization*:

Program Address (line 1)*:

Address (line 2):

City*: State*: AK AL AP AR AS AZ CA CO CT DC DE FL FM GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY Zip*:
Website: (please use the form " http://www.yoursite.org ")

At our event on October 16, we plan to:


Check boxes below if you plan to invite:

Mayor	Governor
Superintendent	Member of U.S. Congress
State Legislator	Other Community Leader(s) (fill-in blank below)

National Affiliation:
4-H Afterschool
Boys & Girls Club of America
Junior Achievement
After-School All-Stars
YMCA of the USA
La Petite Academy
Other:

Number of years program has been operating:
under 1 year up to 3 years up to 5 years up to 7 years up to 10 years 10+ years
Number of students in program:
under 100 100-249 250-499 500-749 750-999 1000+
Funding Sources (check all that apply):
21st CCLC
federal government (not 21st CCLC)
state government (not 21st CCLC)
business
local government
foundation/non-profit
program fees

Check the types of activities your program offers:
homework help
sports and recreation
art/drama/dance/music
academic enrichment
literacy/reading
math/science/technology
mentoring
college/career preparation
drug/alcohol/violence prevention
community service
life skills

Where did you hear about Lights On Afterschool!?


*

*-It takes a moment for your registration to be processed, so please do not click the button more than once. A confirmation email will arrive in your mailbox shortly. Thank you!