Please complete this survey to be able to join us for AMP's Annual Conference which will be on May 21st at Grand View University in Des Moines from 9:30am-3pm.

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* 1. Name

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* 2. Age

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* 3. Phone number

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* 4. Email address

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* 5. Address

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* 6. Emergency contact

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* 7. Allergies

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* 8. Do you have an epi-pen? If yes, please bring it.

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* 9. Do you have any dietary restriction? If so, please specify.

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* 10. Do you need assistance with transportation?

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* 11. What is your current placement type?

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* 12. Would you like to be added to an email list where you will be notified about resources and when AMP has meetings?

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* 13. MINOR RELEASE AND WAIVER OF LIABILITY FOR PARTICIPATION IN SPECIAL AMP ACTIVITIES- Cedar Rapids Mini Camp

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* 14. Youth who register before May 7th are eligible to receive a signed book by Will Keeps. Are you interested in a book?

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