Clone of 2025 ETA Youth Symposium

Deadline: November 10th 2026 Dress Code: A shirt and tie with a *SUIT OR JACKET ARE REQUIRED. No jeans. *SNEAKERS ARE REQUIRED, but please, no Timberlands or dress shoes.
2026 ETA Youth Symposium

Registration Form
STUDENT INFORMATION
Name

First NameMILast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone

Area CodePhone Number
Email
Grade
GPA
Cumulative
Favorite Subject
Extra Curricular Activities
Have you previously participated in the Ebony Tie Affair Youth Symposium?
Can you provide your own transportation?
How did you find out about the Ebony Tie Affair Youth Symposium?
Do you plan to attend college or post-secondary school?
If yes, what will you study?
Do you have any allergies?
If yes, please explain
What is your t-shirt size?
EDUCATION
Current School
School Address
Graduation Year
Counselor Name
What are your plans after graduation?
Emergency Contact Information

Parent/Legal Guardian
Full Name
Relationship
Email
example@example.com
Cell Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Upload COVID-19 Proof of Full Vaccination Status

Browse Files
All attendees must be fully vaccinated or have a negative test result the week of the event. Please upload a photo copy of the vaccination card reflecting full vaccination status or bring documentation for one or the other and present during check-in at the event. Cancelof
PARENT OR GUARDIAN CONSENT FORM
I, {fullName} [Parent/Legal Guardian], hereby grant permission for my child, {name7}, to participate in the 2026 Ebony Tie Affair Youth Symposium ("ETA Youth Symposium")

I specifically authorize the following:
- My child’s completion of a written or verbal questionnaire(s) in connection with the planning and preparation for the event.
- Emergency medical or surgical treatment from a local hospital, or by any licensed health practitioner or dentist in the event of illness, accident or other emergency, if I am unable to be reached.
- My child’s participation in public relations related activities in connection with this event, including interviews, photos and videotaping.
I further agree to fully waive and release from liability the ETA Youth Symposium and its affiliates for any injuries and/or sickness that my child may incur either during or while being transported to and from the ETA Youth Symposium. This waiver and release of liability also extends to medical and/or surgical treatment in case of my child’s illness, accident or any other emergency situation that may occur during the time my child is in the care of the ETA Youth Symposium or its affiliates.
Signature of Parent/Legal Guardian
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Should be Empty:

Deadline: November 10th 2026 Dress Code: A shirt and tie with a *SUIT OR JACKET ARE REQUIRED. No jeans. *SNEAKERS ARE REQUIRED, but please, no Timberlands or dress shoes.

2026 ETA Youth Symposium

STUDENT INFORMATION

EDUCATION

Emergency Contact Information

PARENT OR GUARDIAN CONSENT FORM

Deadline: November 10th 2026 Dress Code: A shirt and tie with a SUIT OR JACKET ARE REQUIRED. No jeans. SNEAKERS ARE REQUIRED, but please, no Timberlands or dress shoes.