Missouri Youth Tour Delegate Form

Missouri Youth Tour Delegate Form
Delegate Name (Legal)*

First NameMiddle NameLast Name
First Name For Your Badge ID*
Sponsoring Electric Cooperative*
High School*
Birth Date*

MonthDayYear
Age*
Gender*
Shirt Size (unisex)*
County*
Your Congressperson*

District 1 – Wesley BellDistrict 2 – Ann WagnerDistrict 3 – Bob OnderDistrict 4 – Mark AlfordDistrict 5 - Emanuel CleaverDistrict 6 – Sam GravesDistrict 7 – Eric BurlisonDistrict 8 – Jason Smith
Delegate E-mail (NOT school)*
We will send important trip updates and information to this address!
Secondary Delegate E-mail*
Non-school or parent email address
Delegate Mobile Phone Number*
For communication during the trip.
We need your photo! A selfie or digital download of your school picture will work fine. Must be clear with your face fully visible.*

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For any questions, please contact Chris Massman at 573-659-3437
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