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Group Directory Form – OLD
Group Directory Form – OLD
EM
2014-06-22T20:03:34-04:00
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
50%
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
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
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
Select files
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
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