NIPD Program/Event Submission Form


Important: If your site is doing multiple things for NIPD, please submit this form multiple times, each item in the correct category. For "Shining a Green Light," please make an entry for each building that is being lit.

NIPD Year:
Program Title:
(For "Shining a Green Light", the program title should be the building name.)
Umbrella Partner(s):

Select the NIPD parnter(s) under which your organization and this event falls. In some cases, an event may be under two or more umbrella partners, for instance sites that are members of both Injury Free Coalition for Kids and Safe Kids Worldwide.

Injury Free Coalition for Kids
American Academy of Pediatrics (AAP)
American Trauma Society (ATS)
JPMA Cares
Safe Kids Worldwide
Safe States Alliance
Society for Advancement of Violence and Injury Research (SAVIR)
Trauma Center Association of America (TCAA)
Unafilliated local partner

Program Type:

City, State:
(Please provide as city, state abbreviation. For example: "Philadelphia, PA".)

Dates and Times:
URL for More Info:

Contact Name:
Contact E-mail:
Contact Phone:
Make contact information public on the NIPD page.


Attachment/Link Instructions

You may upload any publicity materials you may have created, or provide photos of the building to be lit up, among other things. Any attachments to this entry will be public.

To upload a file, fill in the Title field and click Browse... to select the file to upload. If you are editing an existing record, and a previously uploaded file has not changed, YOU DO NOT NEED TO UPLOAD IT AGAIN. Only upload a file again if it has changed.

  Attachment #1
Upload File:

  Attachment #2
Upload File:

  Attachment #3
Upload File:

  Attachment #4
Upload File:

  Attachment #5
Upload File:

Staff Notes:
Staff notes are for NIPD staff only and are not visible to the public.

IMPORTANT NOTE: Please be sure to click the Submit button ONLY ONCE.