NYC Nomination Form

National Youth Congress Nomination Form

Please fill out this form to nominate a member for the 2027 NYC Leadership Program.
As DC/CA/RS I confirm that the nominee is aware that (s)he is being submitted for consideration. If selected as an NYC regional delegate, delegates must:
- Arrive by Thursday, January 28 and participate through Sunday, January 31st, 2027
- Register for an All-Access Pass for Convention (which includes lunch Thursday-Saturday)
- Purchase a Saturday night Banquet ticket
Hotel is covered by USPC for Thursday through Saturday nights (2 delegates to a room). Regions shall pay a $250 program fee to help offset hotel and program costs. If a region wishes to cover all of the above fees for a delegate in addition to the program fee, that cost will be available after October 1, 2026.
- Nominee's Name
  
  First NameLast Name
- Nominee's Phone Number
  Format: (000) 000-0000.
- Nominee's E-mail Address
  example@example.com
- Nominee's Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Age as of January 1, 2027
  Must be between 18-23
- Current National Certifications:
  Must be H-B, H-A, C-3, B or A
- Club/Center
- Region
- Your Name
  
  First NameLast Name
- Your E-mail Address
  example@example.com
- Your Phone Number
  Format: (000) 000-0000.
- Should be Empty:

National Youth Congress Nomination Form