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Registration and Materials Request Form

If your organization is ready to plan a campaign, please complete the form below so we can reserve You Know Different materials for you.

If you only need general information about You Know Different, please request it here.
Contact name: A value is required.
Title: A value is required.
Organization name: A value is required.
Agency web site:
Phone: A value is required.
E-Mail Address: A value is required.Invalid format.
Mailing address: A value is required.
Apt/Suite Number:
City: A value is required.
State: A value is required.
ZIP: A value is required.
Shipping address
(if different from mailing address above; no PO boxes)
Apt/Suite Number:
City:
State:
ZIP:

Campaign Materials

Campaign materials are you requesting:

Campaign Toolkit
Posters
Palm cards
Stickers
Rubber bracelets
We already have campaign materials

Once you are registered, you will be able to access You Know Different art and viral components on the web page! These tools will allow you to supplement the materials you receive with your own campaign flyers, ads, posting, etc.

Estimated 2-week period of campaign

Start date (mm-dd-yy): A value is required.Invalid format.

End date (mm-dd-yyyy): A value is required.Invalid format.

Image selection (please pick no more than 2 images):

original image
plaid shirt
club guy
transfemale
Please select no more than 2 images.Please make a selection.

Campaign Webpage

NYAC would like to list your organization on the You Know Different web page? Do you give NYAC permission to list you?


(If "Yes," NYAC will follow-up with you.) Please note this option takes at least 4 weeks' prior notice.


Thank you! You can expect confirmation and follow-up from a NYAC staff person concerning this request within 3 business days.

 
   
   

 
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