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Register to Host a CLT Watch Party

Campus Liberty Tour Watch Party Event?*

Name*

First Name M.I. Last Name

Address (Where you would like Watch Party materials sent)*

Street Address Address Line 2 City State ZIP Code

Phone*

How many people will attend? (Estimate)*

Email*

Date of Birth

College Name, if applicable

Campus Organization Name, if applicable

Your Campus Organization Title, if applicable

Relationship to College

Student

Faculty

Other

Not Applicable

Statement of Authenticity*

I hereby certify that the information provided in this application is true and complete to the best of my knowledge.

Phone

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