SpeakUp! Event Registration

Please complete the form below to register for an upcoming SpeakUp! event:
Participant Info
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Speakup Staff
You can select from contacts that have been previously assigned to a Facilitator, Staff, or Volunteer Group in CiviCRM
Choose Prior
Select the SpeakUp! Event you're registering for:*
Name*
.
First Last
Address*
Street Address City State Zip Code
Email*
Phone*
Phone number will be used if additional support is needed during or after the event.
Which gender pronouns do you identify with?*
Are you on the Student Leadership Team for this event?*
Participant Type*
School Staff Type*
Which school are you associated with?*
Student's grade*
Student's High School Graduation Year*
Grade to Graduation Year Chart
6th: 2031
7th: 2030
8th: 2029
9th: 2028
10th: 2027
11th: 2026
12th: 2025
Breakout Session
You will be participating in ONE Breakout Session. Please Rank your top Breakout choices in order of preference: (1-3)
Topics (click here to view topic talking points)
Bullying
- What does MH mean?
- Depression/anxiety
- Undiagnosed illness
- Medication
- Trauma
- Urban areas
- Self-harm
- Addiction
- Discipline
- Seeking help/reaching out
- Social Media
- Anger issues
- Drug use
- Body Image
- Insecurities
- Self love
- Self-resepect
Mental Health
- Anything can be a addiction
- What makes an addiction?
- How to deal with addiction?
- Social Media
- Self-harm
- Food/money/video games/sex
- How to care for someone w/ addiction
- How does addiction effect you?
- Stressed
- Anxiety/paranoid
- Medicine
- Weak/unhealthy
- Drugs/alcohol
- Bullying
- Peer pressure
- Family history of addiction
- Mental Health
- Trauma
Social Life
- How do you know who to trust?
- How do you know when you're in love?
- Loyalty/trust/respect
- How to choose the right friends
- How to get closer with family
- Acceptance/perspective
- How to build good relationships
- How do you define a relationship?
- Moving on from a bad situation
- Friends come before partner or vice versa
- What's the difference between friendships & relationships?
Sex Education
- Why teens might feel the need to have a child to feel loved?
- Sex heavily protected but not spoken about enough
- Lack of teens educated on their bodies
- Risks of unprotected sex
- STD's
- LQBTQIA+
- Psychology of sex
- Uncomfortable to talk about w/ adults
- Unstigmatized conversation on sex
- Sanitary/safe precautions/practices
- Soul ties/emotional connection
Topics: 1st Choice*
Topics: 2nd Choice*
Topics: 3rd Choice*
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Topic/Room Selection
Note: Please be sure you have selected 3 different Topics.
*We will do our best to give you your first choice topic, but it is not a guarantee.*
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Contact Preference
- Click here to opt-out of Speakup! emails which include valuable resources, Parenting Adult Coffee Invitations, School Adult Discussion Invitations, Youth Mental Health First Aid Training Opportunities and much more.
Will other family members be attending this SpeakUp! event?
Family Members Attending
NOTE:THIS DOES NOT REGISTER THAT FAMILY MEMBER. All Participants must register separately. Listing family members below ensures you will not be in the same breakout with those listed.
Attending Family*
First name Middle initial Last name This person is my
e.g. Parent's name is John Smith and email is [email protected], and student's name is also John Smith with an email address of [email protected]
- My name and email address are the same as my child or parent.
e.g. Parent's name is John Smith and email is [email protected], and student's name is also John Smith with an email address of [email protected]
Name
This field is for validation purposes and should be left unchanged.

First name	Middle initial	Last name	This person is my

Participant Info

Breakout Session

Topics (click here to view topic talking points)

Bullying

Mental Health

Social Life

Sex Education

Family Members Attending

Special thanks to our Corporate Partners

SpeakUp!