Clone of 2025 Black History Trip Sign Up Form

2026 Black History Trip - Montgomery, AL - Feb. 21-22

Please complete the registration form carefully. (A SEPARATE FORM IS REQUIRED FOR EACH CHILD). YIA will be in contact with you with additional information. Price is $50 per person. Open to Grades 4 through 12.
Child's Full Name*

First NameLast Name
Child's Age*
Parent/Guardian Name *

First NameLast Name
Parent's E-mail*
Parent's Phone Number*

Area CodePhone Number
Do you already receive the YIA eNewsletter?

YesNo
Would like to be added to the Youth in Action email/text blast list?*

YesNoNot Applicable
Registration Payment
To make your $50.00 registration payment, click or tap here

-OR-

click this image

Contact Elder, David Bishop regarding payment challenges you may be facing. We will work with you.
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2026 Black History Trip - Montgomery, AL - Feb. 21-22