Register a business or organization

Owner/Leader Name(Required)

First Last

I am the owner/leader of the business/organization.(Required)

Yes

What‘s the name of the business/organization you’re registering?(Required)

Business/Organization point of contact

First Last

Mailing address of business/organization(Required)

Street Address Address Line 2 City State ZIP Code

Is your physical address different from your mailing address?

Yes

Physical Address

Street Address Address Line 2 City State ZIP Code

Business/Organization Email(Required)

Business/Organization Phone

Why are you registering this business/organization as a SAFE Space?(Required)

How did you learn about the SAFE initiative?

Do you have any comments or questions about the SAFE pledge?

Has the SAFE pledge been signed and decal received?

Yes