Youth & Teens Registration Form

Launchpad Registration Form - Youth & Teens

Fill out the form carefully for registration. You will receive a confirmation.
Student Name*

First NameLast Name
Age*
Number
Grade in School*
Number
What is your GPA on a 4.0 Scale?
GPA
School*
City, State*
Parent Name*

First NameLast Name
Email*
example@example.com
Mobile Number*
Phone Number
If register ON OR BEFORE NOV. 8TH, WRITE "FREE" IN THE COUPON AREA.)*
Yes or No
Are you applying for a Grant? (You must be receiving State benefits.)*
Yes or No
Are you applying for a Scholarship? (You must have a GPA of 3.0 or higher on a 4.0 scale.)*
Yes or No
Enter the "GRANT" or "SCHOLAR" COUPON CODE BELOW, if applying. Documentation must be presented upon request.
DO NOT WRITE IN THIS BOX

My Products*

MindSpire LaunchpadMindSpire Launchpad is an interactive workshop for students ages 8-12 and 13-17, focusing on mental, emotional, and financial health. Participants engage in activities and hear from motivational speakers, learning strategies to build confidence, resilience, and smart decision-making skills.

$59.00 Quantity

Enter coupon

Total

$0.00

Payment Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Should be Empty:

Launchpad Registration Form - Youth & Teens