Contact Person InformationCompany, School or OrganizationContact Name* First Last Contact Email* Phone*Gender*MaleFemaleDate of Birth* Educational LevelExperience Working with Middle School Girls*5+ Years1-4 YearsLess than 1 YearNoneI/We Would Like To:*Start a ClubHost a CampProgram InformationClub or Camp AddressStart Date Preferred Days* Select All Monday/Wednesday Tuesday/Thursday Saturday Preferred Time* Select All 10am-1pm 1pm-3pm 3pm-5pm Preferred Format*Open to the PublicPrivateSports or Physical Activities Offered Double Dutch Golf Hockey Lacrosse POUND Soccer Softball Tennis Ultimate Volleyball Other STEM Topics or Activities Covered (Please Specify)Number of Girls You Can Accommodate*Up to 1011-2021-3031-4041-4950+How did you hear about Play Like a Girl?MagazineRadioTelevisionOnlineSearchSocial MediaWord of MouthCAPTCHANameThis field is for validation purposes and should be left unchanged.
