PTM Foundation Land Acknowledgement Partner Form

Please fill in your information below and someone from our team will be in touch!

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* 1. What is your first name?

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* 2. What is your last name?

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* 3. What is your phone number?

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* 4. What is your email address? (Primary Contact)

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* 5. What is the name of your organization?

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* 6. What is your organization or Tribe's mailing address?

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* 7. What is your Tribal affiliation? (Please list all that apply)

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* 8. What is your official website? (If there are multiple sites, please include all)

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* 9. Please list any additional email addresses you would like copied on communications about partnering with PTM Foundation

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* 10. Please include a short blurb about your organization and/or Tribe's mission and work (1-3 sentences)

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* 11. Please upload your organization or Tribe's logo in hi-resolution

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

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* 12. Please upload a hi-resolution photograph we can use to promote your organization or Tribe on social media

PDF, PNG, JPG, JPEG file types only.

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In order to comply with various national, state and/or local laws, or venue regulations, we ask the following questions regarding COVID-19.

“Fully vaccinated" means that (a) you have received the second dose of a two-dose COVID-19 vaccine (Pfizer or Moderna) or after receiving the single-dose COVID-19 vaccine (Johnson & Johnson) and (b) if it is more than five (5) months after you received the second dose or single-dose referenced above, you have received a booster shot.

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* 13. Are you fully vaccinated? If yes, please provide dates of vaccinations.

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* 14. Prior to the Land Acknowledgement, will you be able to provide proof of vaccination either with a copy of your vaccination card or through a state or federal application or website offering proof of vaccination?

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* 15. If necessary, would you be able to submit proof of a negative COVID-19 test prior to the Land Acknowledgement?