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Youth Leadership Registration
Participant's Name
*
First
Last
Grade During 2020-21 School Year
*
9
10
11
12
Participant's Photo
*
T-Shirt Size
*
Adult X-Small
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Address
*
Street Address
Address Line 2
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Participant's Leadership Package will be sent to this address (Includes T-shirt, work packet, etc...)
Parent/Guardian Name
*
First
Last
Parent/Guardian Phone
*
Parent/Guardian Email
*
Email address will be used to send course webinar links
Youth Leadership Program
*
Price:
$187.00
Credit Card
Card Details
Cardholder Name