Youth Leadership Symposium Day at the Capitol Registration Ends Friday May 1, 2026

Please have each attending student complete this form.

IMPORTANT INFORMATION:

*$25 registration fee per person

*There is ABSOLUTELY NO ON-SITE Registration!

*One registration form is to be completed for each student.

*Breakfast and lunch are included.

*A t-shirt is included in the registration.

Please send and make all checks/money orders payable to:

Erica Austin

1836 Brian Lane

Springfield, IL 62703

Electronic Options:

1. Paypal: 217-553-1815

2.Venmo: 217-553-1815

3. Apple Pay: 217-553-1815

4. Cash App: 217-553-1815

Everyone will receive a receipt!

We ask that every participant wears tan khakis on the day of the event and the provided t-shirt.

Letters of Excuse will be emailed out to you a week before Day at the Capitol.

For questions about the event, contact:

Jennifer Douglas, Nu Omicron Omega

YLI Committee Chair

P: (217-381-2002)

E: jenjoiner821@icloud.com

Email address*

First Name*

Last Name*

Phone Number*

Do you text?*

YesNo

Can we add you to GroupMe messaging for the day?*

YesNo

Grade*

ALPHA/AKA Chapter Affiliation *

Location*

Group Leader Name*

T-Shirt Size*

School Name*

Emergency Contact*

Relationship*

Phone #*

Thank you for signing up! We look forward to interacting with you! Please download the GroupMe messaging app to stay up to date on the day of the event. You can also join by clicking the link below. See you soon! https://groupme.com/join_group/106593820/LawMwqNQ