Champions of ChangeClimate Pledge Arena Friday, June 23, 2023, 7:00 pm Register Now to Request Complimentary Tickets Name * First Name Last Name Email * Phone * (###) ### #### Race/Ethnicity? * American Indian or Alaskan Native Asian / Pacific Islander Black or African American Hispanic White / Caucasian Multiple ethnicity / Other Is your family low income, underserved, or fostering? * Yes No How many children in your family that are 12 years old or under? 1 2 3 4 5 How many teens in your family between the ages of 13 - 17 years old? * 1 2 3 4 5 6 How many adults 18 years and over are in your family? * 1 2 3 4 Do you accept the Cinematique Participation Agreement and Release? * See the Cinematique Participation Agreement and Release here. https://drive.google.com/file/d/1eEC71xEpimK7qoy-GMxsN-zrCWC9h_8S/view?usp=sharing Yes No Join Our Mailing List? Yes No Do you have an EBT Card? Yes No Does your family qualify for SNAP (Supplemental Nutrition Assistance Program)? Yes No Are all adults in your family registered to vote? Yes No Thank you for requesting complimentary tickets to attend Champions of Change on June 23, 2023, 7 pm, at Climate Pledge Arena.Our goal is to accommodate all registrations. Due to high demands for this event and limited resources, unfortunately, we may not be able to accommodate all registrations. Registrations will be processed in the order they are received. We will get back to you shortly on whether your registration has been accepted for attendance at this event. Once your registration has been accepted, complimentary tickets will be sent to you at the email address included in your registration request.Thank you for your patience as we continue to work with our sponsors and partners to maximize our impact across our community for those who need us most. If your plans change and you are not able to attend, please email us at yeadon@essexcommunityoutreach.org. Visit join our mailing list and visit our website often for updates on future events and resources.
