2 Name & Contact Information

Note: Since English is not the primary language of your organization, you can enter certain information in your primary language by filling out the 2nd Language boxes.

Organization Name: 2nd Language:

Organization Acronym: 2nd Language:

Phone Number: Fax Number:

Email Contact 1: Email Contact 2: Email Contact 3: Email Contact 4: Email Contact 5:

2 Address Information

Address Line 1: 2nd Language:

Address Line 2: 2nd Language:

City:

US State: Postal Code:

Other Region: (if not in United States)

Country:

3 Mission & History Information

Brief Background: Please provide a brief summary of your organizations mission and history. (200 words maximum).

5 Affiliations Information

Sponsors:

Name:

Coca Cola Corporation

Type:

Sponsor