Urban Youth Entrepreneur Academy

Membership Application

To apply for membership please complete all questions.
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Student E-mail
example@example.com
Parent E-mail
example@example.com
Home Number

Area CodePhone Number
Cellular Number

Area CodePhone Number
What school do you attend?
What grade are you?

Other
If you have a business what is your business name? (put N/A if you don't have a business)
What type of business do you have?

Other
Do you currently operate a business
Products
prevnext( X )
UYEA Membership (Youth)$60.00
1 year membership

Tuesday Business Booster$10.00
1 day workshop

UYEA Membership (Adult)$100.00
1 year membership

Soap Box Derby $120.00
Seasonal Membership

Quantity

Total $0.00
Name

First NameLast Name

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Membership Application