Area-Wide Campaign Interest - dfree Movement

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Dfree® Area-Wide Campaign Interest Form

Campaign Interest Form

"*" indicates required fields

Name of Individual or Organization*

Type of Participant*

Individual

Nonprofit or Community Group

Church or Faith-Based Organization

Business

Financial Institution

Government Agency

Other

Select one or more:

Other*

Are you interested in:*

Hosting a DFREE® 12-Step course

Becoming a certified DFREE® facilitator

Referring participants to the campaign

Sponsoring the campaign (financial or in-kind support)

Helping coordinate campaign events or logistics

Participating in the graduation ceremony

Other

Select all that apply:

Other*

Geographic Area You Represent or Serve*

Why are you interested in participating in a DFREE® campaign?*

Have you participated in or supported a DFREE® campaign or activity before?*

Yes

No

If yes, please describe briefly*

Key Contact Person

Full name*

Title/Role*

Email*

Phone number*

Zip code*

Organization Website or Social Media (if applicable)*

Additional Notes or Questions*

Consent & Communication Preferences

I agree to be contacted by the DFREE® Foundation regarding this campaign.

I would like to receive updates about DFREE® campaigns, events, and training opportunities.

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(844) 693-3733

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(844) 693-3733

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