* 1. Name of School:

* 2. Street Address:

* 3. City, State, Zip Code:

* 4. Phone Number:

* 5. Fax number:

* 6. Contact Person:

* 7. Contact person email:

* 8. School club or organization:

* 9. Estimated number of youth involved:

* 10. Please let us know how you might participate. The event is May 15-17. We will send additional information to the contact person. Select all that apply.

* 11. Do you have more than one youth organization or school you would like to register?

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