* 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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