Group Directory Form – OLD – Virginia Tea Party

Organization Registration

Please input your organization's data for the VTPP statewide online map. This form is completed in (2) steps:

STEP 1:
Private information of your organization's group contact person who is authorized to complete this form

STEP 2:
Organization contact information that can be viewed publicly

Step 1 of 2

Organization Name*

Official organization name
Organization Leader's Name*
First Last

Name of authorized representative of organization
Org Leader's Email Address*
Org Leader's Mobile Phone
Org Leader's Home Phone

Official Organization Contact Information
This information will be used as contact information that the general public can view to contact/find your organization. Do not use personal/private information that you do not want displayed online.
Official Organization Physical Address
Street Address Address Line 2 City State ZIP Code

This address will be used to locate your organization on a map. If your group does not have a physical address, please indicate something like a local city hall, library you use for meetings, or at least a specific zip code that your organization covers. Zip code is required at a minimum to place a pin on the map for the general area your organization covers.
Organization Physical Address Notes
If you need to give specific instructions/details about your organization's location, please do so here.
Org Mailing Address
Street Address Address Line 2 City ZIP Code

Organization mailing address (if applicable)
Organization Public Website Address

Internet website address to where you'd direct the public to find your organization.
Organization Public Contact Email Address

Enter an email address that the public would use to contact your organization.
Organization Official Phone Number (if applicable)
If your organization has a public phone number that you want to share, indicate that here.
Organization Logo
Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 256 MB.
Your organizations logo, if you have one. File upload capped at 64MB, so please optimize your logo prior to upload.
Attestation*
- Agree
I understand that my organization's public information in step 2 of this form will be used to create a public online map of tea party organizations across Virginia.
Captcha Verification
Enter the text below to verify human entry and to defeat bot/spam submissions.