Master Guide Conference Change Request Form
Northeastern Conference AYM
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Conference Name
*
Conference Phone Number
*
Master Guide Coordinator
Master Guide Coordinator Email
Youth Director
*
Youth Director Email
*
The Youth Director Signature confirms: the above named candidate requests permission to enter the Northeastern Conference Master Guide Training Program. He/She is a member in good and regular standing. I acknowledge the candidate, and the conference are aware of their participation in the training program upon approval from the Northeastern Conference Youth Department Directorate.
*
FOR NORTHEASTERN CONFERNCE OFFICE USE ONLY
Request for participation in the Northeastern Conference Master Guide Training program is
Approved
Denied
Northeastern Conference Youth Director Signature
Date
-
Month
-
Day
Year
Date
Submit
Should be Empty: