National Program Request Form

notMYkid National offers different levels of program support to best serve the needs of each requesting school or community organization.

In order to best serve your needs, we ask that you complete as much information as possible on the form below.

Once finished, please click the submit button at the bottom of the page.

If you have any questions , please contact Julie Shockley at 602-652-0163 or Julie@notmykid.org

Requestor Name: *
Requestor Postion: *
Requestor Phone: * (numbers only, no dashes)
Requestor Email: *
How did you hear about notMykid National Program?
School District Name:
Full Address:
School Phone:
Fax:
Preferred program date(s):
Is there another event planned to coincide with the notMykid National Program?
Check this box if you would like to be added to our email list.

notMYkid.org | 5230 E. Shea Blvd. Suite 100 | Scottsdale, AZ 85254 | 602-652-0163