2009 SMYAL Youth Leadership Conference
To register for the 2009 SMYAL Youth Leadership Conference on October 10, 2009 from 11am to 5pm, please fill out the information below.
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First Name
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Last Name
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Date of Birth
(If you are under the age of 18, you will require parental consent to attend this conference. Please download the consent form from the SMYAL website and bring the signed form with you on the day of the event.)
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Street Address
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City
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State
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Postal Code
School
Grade or year in school
Organization
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Home Phone
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Cell Phone
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Email Address
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Emergency Contact:
First Name
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Emergency Contact:
Last Name
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Street Address
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City
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State
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Postal Code
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Home Phone
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Cell Phone
Meal Preference
Meat
Vegetarian
Vegan
None
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Do you have any allergies?
Yes
No
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If yes, please list all allergies below.
0/7 characters
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If you require medication or special accommodations for your allergies, please list all below.
0/7 characters
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If you have any other medical conditions or require medication, please list all below (asthma, inhaler, epilepsy, etc.).
0/7 characters
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