This information will be publicly displayed with each event you register. Fields marked (* ) are required.
Fields marked (* ) are required
Organization Name *
Event Address *
Address Line 2 (optional)
City *
State/Territory *
- Select - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Federated States of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico Virgin Islands Armed Forces Americas Armed Forces Europe Armed Forces Pacific Other
Other State/Territory
Zip/Postal Code *
Country *
- Select - United States Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo (Brazzaville) Congo (Kinshasa) Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong S.A.R., China Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Ivory Coast Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao S.A.R., China Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands North Korea Norway Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu U.S. Virgin Islands Uganda Ukraine United Arab Emirates United Kingdom United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican Venezuela Vietnam Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe
What best describes your organization? *
- Select - K-12 school College or university Health care organization (including addiction treatment centers) State, tribal, or local government (including law enforcement, courts, and health departments) Community organization (including prevention coalitions) Student organization Unaffiliated Other (please specify)
Tell us more
Has your organization previously hosted an NDAFW event? *
- Select - Yes No
How did you hear about us?
Email from NIDA NIDA website Twitter Facebook LinkedIn Other social media A colleague A friend or family member Online advertisement A national organization (please specify) A state or local organization (please specify) A government agency other than NIDA (please specify) Other (please specify)
What is your organization's Facebook handle? (optional)
Please list any additional social media handles. (optional)
Do you receive any federal funding for substance use prevention activities? (optional)
- Select - Yes No
If yes, from which agency/program?
About your event
Event Type
Assembly (activity such as a speaker, a presentation, a video screening, etc. with all or most of your school) Campaign (educational, communications, etc.) Contest (poster, video, art, etc.) Game (drug facts trivia, scavenger hunt, etc.) Setting up an information table Social media campaign Presentation or panel (to a class or individual group) Display (series of posters or bulletin boards) Other
Tell us more
How many people do you expect to attend the event? If you are unsure, please provide your best estimate. (optional)
On what topic area are you holding your event? (optional)
Alcohol Drunk/drugged driving Marijuana Opioids and other Rx pain relievers Tobacco, nicotine, and e-cigarettes Mental health Substance use treatment Synthetic drugs (such as K2 or bath salts) Prescription stimulants (“study drugs”) Emerging drugs (such as “Calvin Klein” or “sizzurp”) Prescription depressants (“benzos”) When mental illness and substance use disorders occur together Stress-reduction/resilience Addiction science and the developing teen brain Drugs [in general] Drugs and alcohol [in general] Other
Tell us more
Please provide a brief description of the proposed event. *
What do you plan to do? Who is your audience? (e.g. specific grades of students, parents, etc.) Does your plan involve other organizations?
