Youth Empowerment Summit (Y.E.S.) Registration Form

Youth Empowerment Summit (Y.E.S.) Registration Form

Please fill out the form below in order to register for the Youth Empowerment Summit that will take place on April 22, 2023 from 9am to 2pm at the Village Conference Center located at 1444 E Holt Ave, Pomona, CA 91767.
Are you a:

StudentAdvisor
Your Name:*

First NameLast Name
Email*
example@example.com
Pronouns*
What are your pronouns?
Phone Number
Please enter a valid phone number.
Age/Grade*

How old are you?What grade are you in?
What city do you live in?:*
T-Shirt Size*
Sexual Orientation*
What is your sexual orientation?
Current middle or high school:*
What school do you attend?
Gender Identity:*
What gender do you identify as?
Advisor Name:
If you are a student, please list your GSA advisor here.
Should be Empty: