Demonstration Request

Demonstration Request
Name of demonstration requestor (individual):

First NameLast Name
Name of demonstration requestors (group)
Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
Contact Email
example@example.com
Date and time requested

MonthDayYear
Date
Hour MinutesAM/PM Option
Expected number of participants
Topic of demonstration
How do you plan to advertise?
Do you plan to utilize signs, flags, bullhorns, etc.?
Describe your previous involvement with demonstration activities
By submitting this form, requestor(s) affirm that they will utilize all efforts to ensure the demonstration is peaceful and does not disrupt Institution activities or activities of other groups utilizing space nearby, including by avoiding hate speach in all its forms and abiding by Institution rules and regulations. Requestor(s) acknowledge and understand that if any information submitted is determined to be false, their request will result in an automatic denial.
Should be Empty: