Survey - NEDAwareness Week Landmark Lighting Photographer Survey 2021

1.

Please fill out the below:

*

Name:

Title	First Required	Middle Required	Last Required

*

Email: Required

*

City/State/ZIP:

City Required	State Required	ZIP

Phone Number:

Yes, I would like to receive e-mail from National Eating Disorders Association

Yes, I would like to receive postal mail from National Eating Disorders Association

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*2.

Question - Required - Which building lighting would you like to attend? (We welcome more than one volunteer committing to a lighting)

(Maximum response 255 chars, approx. 5 rows of text)

3.

Question - Not Required - Date of scheduled lighting:

Month

Day

Year

*4.

Do we have your permission to use your name in social media?

(Select one of the available choices or enter a different value.)
Question - Required -

5.

Question - Not Required - Instagram account handle:

(Maximum response 255 chars, approx. 5 rows of text)

6.

Question - Not Required - Twitter account handle:

(Maximum response 255 chars, approx. 5 rows of text)

*7.

Question - Required - I commit to submitting the pictures I take to NEDA in a timely manner and give NEDA full permission to use my photographs on social media and for marketing purposes as they see fit.