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  1. Surveys
  2. 2012
  3. August
  4. T
  5. The Baltimore Wake Up
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Hello:
Welcome to The Baltimore Wake Up! It will take approximately 2 minutes or less to fill in your registration information.

It is very important for us to have accurate information. This will be the information used to guarantee your admission and confirm participation for this FREE event.

Your responses will be kept confidential and not shared with anyone else. The information will only be used by the program leadership to evaluate the effectiveness of The Baltimore Wake Up initiative. If you have questions about the event itself, you may go to www.thebaltimorewakeup.org for further information.

Thank you in advance for registering for The Baltimore Wake Up happening on October 13, 2012. Please start with the registration form now by clicking on the Continue button below.
 
 
 
* First Name : 
* Last Name : 
* Address 1 : 
   Address 2 : 
* City : 
* State : 
* Zip : 
Phone : 
* Email Address : 
 
 
 
* What is the name of your neighborhood? (Example: Park Heights)
   
 
 
 
* How many years have you lived in your current neighborhood?
   
 
 
 
* If you could improve 3 things in your neighborhood what would they be?
   
 
 
Select your top two choices for community projects you would like to do (for all other choices select N/A):
1st Choice 2nd Choice N/A
* Green Space/Gardening
* Clean up/Beautification
* Mentoring Activities
* Substance Abuse Education and Training
* Other (original community project idea)
 
 
 
* What is your gender?
 
Male
 
Female
 
 
 
* What is your age range?
 
14-17
 
18-25
 
25-34
 
35-50
 
50+
 
 
 
* How did you hear about The Baltimore Wake Up event (Select all that apply)?
 
Friend
 
Community Event
 
Newspaper
 
Postcard Handout
 
Television
 
Radio
 
Non-profit Organization
 
Email
 
Social Media (Facebook, Twitter, etc.)
 
Other
 

 
 
 
Put the email addresses of up to five people you want to invite to The Baltimore Wake Up:
   
 
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