Next Generation Advocates: Youth Civic Leadership Conference
Student Name
*
First Name
Last Name
Age
*
School
*
Grade
*
Please Select
5th
6th
7th
8th
9th
10th
11th
12th
Student E-mail:
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student Phone Number
Name of Parent/Guardian
*
Parent Email
*
example@example.com
Parent Cell Number
*
Emergency Contact Name (If Different)
Emergency Contact Phone Number
Do you have any food allergies or dietary needs?
*
Do you need any accommodations to fully participate? (Examples: accessibility needs, learning supports, etc.)
What interests you most? (Check all that apply):
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Government and Democracy
Legal System and Rights
Advocacy and Civic Action
Voting and Elections
Community Leadership and Service
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