2022 YA Leadership Summit Registration
please contact Patricia with any questions: pyoung@joinrisebe.org (860) 549-2435 Date: Friday February 18th, 2022 via Zoom
Name
First Name
Last Name
Email-Required
example@example.com
Phone Number
Please enter a valid phone number.
Are you between the ages of 18 and 29?
Please Select
Yes
No
Younger than 18
Older than 29
How many people are you registering for including yourself?
Please provide the names and email addresses of each person you are registering for.
Are you affiliated with a YAS program in Connecticut? If so, which one?
If you are part of a YAS program please provide the name, email address and phone number of the best contact person for your program.
Submit
Should be Empty: