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Organization/Group Registration
  We invite you to list your organization in the National Juneteenth Register.  As a member, you will be included in the dialogue, discussions and information exchange supporting the Juneteenth community.  Also, your participation will help strengthen our national efforts to secure media support, volunteers and other resources made available through potential sponsorships and corporate partners. Your organization's information is vital in assessing the social and financial impact of Juneteenth celebrations across the U.S.  Please be as thorough as possible.  (We respect your privacy.  Your information will be compiled for composite and statistical purposes only, to help us gauge the social and financial. impact of Juneteenth celebrations across the U.S.)

Type of Membership:  Group, Non-Profit, Club, etc.

Name of Organization: 



State:   Zip:  

Tel:  ()   -   Ext.:

Fax: () -


Web Site:

Contact Name:
Contact Telephone Number(s) (Home, Office, Cell)

How did you hear about

Majority Age Group of members:
0-30     31 - 45     46-55     over 55

Race / Nationalities of members:

Number of years celebrating Juneteenth:

*Tell us about your organization (age, size, mission, Juneteenth activities, etc.):

How is your Juneteenth event funded?

Is your organization interested in sponsorship for your Juneteenth events?  If yes, are there particular areas/expenses in which you would direct such funds?

Approximately, how many people attend your event?
Describe the activities that are typically hosted at your Juneteenth event.

Approximately, what is  the budget for your Juneteenth event?  $
On what items does your organization typically spend money  in preparation for your Juneteenth event?

What items do you typically sell at your Juneteenth event?

Do you recruit local or national talent to perform at your Juneteenth event?

Is your event covered by local or national media?

Do you have an estimated economic impact of your event?

*Are you a member of or affiliated with any other national Juneteenth organizations?   If yes, please list affiliations, if no please state "none":

Would you like to receive information from other national Juneteenth organizations?
(Yes / No)

Yes, we would like additional information on the Juneteenth World Wide Celebrations products to accessorize our event.

Favorite Web Sites: 
Suggestions for the Web Site: 

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