The New Hampshire You Summit on Opioid Awareness Save My Space!

Save Our Seats!
The New Hampshire Youth Summit on Opioid Awareness

To reserve seats for your school/organization, please complete the form below.

Please indicate the number of students and teachers/chaperones that will be attending the Summit. Once you have reserved your seats, please have each student complete a participant permission form. We must receive the completed permission forms for all students before tickets are mailed to your school.

School/Organization Contact Person Name: *

School/Organization Name: *

School/Organization Address 1:

School/Organization Address 2:

City/Town:

State:

Zip Code:

Email Address: *

How many members of your school/organization would you like to reserve space for?

(Please remember that you will not receive tickets until all participant permission forms have been received.)

Number of Teachers/Chaperones/Adults Attending: *

Number of Students Attending: *

Total Number of Attendees Planning on Attending: *

What form of transportation will you be using to attend the event? *

Car Bus Public Transportation

Will you require parking at the event? *

Yes No

Will you need to leave before 12:00 PM? *

Yes No

Will any of your students or chaperones require special accommodations, i.e., wheelchair access, sign language interpreters? *

No