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First name

Surname

Village/Town/City

Postal code/zip code

Language (i)

Country

Young person (25 years and under) Individual Teacher Parliamentarian or decision-maker Representative of an organisation or company

Age

Are you planning to take part in:

Name of school/college/university

City/town

Name of your group

Which town/city is your group based in?

Where will you be running your activity? For example, a community centre, an outdoor space.

Estimated number of people taking part in the activity

Age range of participants

Will you be inviting a parliamentarian or decision-maker?

Tell us a bit about your event or activity, for example: what will you be doing? Who will be participating? What are your demands?

Name of parliamentarian or decision-maker

Age

Participating on your own or in a group?

How many of you will be participating?

Tell us a bit about your event or activity, for example: what will you be doing? Who will be participating?

Name of your school

City/town

The name of the invited decision-maker

Estimated number of students taking part in the activity

Age range of students participating in the lesson/assembly

Will you take part in the world’s biggest screening on the 14th November?

Can we list your school on the global map of participating schools?

Which area do you represent?

Would you like to attend an event at:

What is the preferred location in which you would like to participate?

Name of organisation

Overall, is your organisation:

Which level of the organisation are you responding on behalf of:

Who will be taking part in your activity:

Will you take part in the global screening on the 14th November?

Please tell us more about your planned activities

It’s not compulsory, but while you’re here, would you like to take the 100 Million pledge?
I pledge to do all I can to end child labour, ensure education for all and eradicate violence against children so that every young person is free, safe and educated.

I would like to be part of the 100 Million movement and receive activist materials and news from the 100 Million campaign globally and in my country.

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(i) We will try to ensure all materials are available in English, Arabic, Spanish, French, and Portuguese. The film, The Price of Free, will be available in English, Arabic, Spanish, French, Portuguese, Hindi, Indonesian, Bengali, German, Japanese, Korean, Tamil, Telugu, Nepali, Dutch, and Swedish.