Registration Form
YLU- The Breakthrough
Full Name
First Name
*
Last Name
*
Affiliation
Institute
Positon
Parent
Educator
Administration
Other Youth Services
Contact Info
E-mail
*
Phone Number
City
Workshops
Choice One Workshop
*
Engaging Male Students - (20 people)
Trauma 101- (20 people)
Teaching the Creative - (20 people)
Choice Two Workshop
*
Engaging Male Students - (20 people)
Trauma 101 - (20 people)
Teaching the Creative - (20 people)
Childcare is being offered for children 2-13 years old. Please select the number of children & increase your payment amount below.
One Child + $10
Two Children + $10
Three Children +$15
Four or more children +$20
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