WHTA Youth Council Membership Form

WHTA Youth Council Membership Form

Please fill out your details to register with the Youth Council.
Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Home Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Please send membership payment ($10) to the WHTA Youth Council venmo:

@whtayouthcouncil

Would you like a Youth Council t-shirt? If so, please enter your size in the designated spot below and send payment ($20) to the WHTA Youth Council venmo. IF you do not have venmo, please reach out to Kasie Sanderson, Heidi Waddell, Maria Bobo or Lexie Helton and we can arrange payment!
WHTA Youth Council T-Shirt Size:
Should be Empty: