Youth Distribution List

Please provide the following information to be added to our customer email database.

Question Title

* 1. Youth Information

First Name

Last Name

City of Residence

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* 2. Youth Information

Birthdate

Date

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* 3. Youth Information

Male

Female

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* 4. Does the Youth have any special needs?

Yes

No

If yes, please specify.

Question Title

* 5. Parent Information - Service Member

First Name

Last Name

City of Residence

Phone Number

Question Title

* 6. Parent Information - Service Affiliation

Air National Guard

Army National Guard

Question Title

* 7. Parent Information - Rank

Question Title

* 8. Email address to include in distribution list

If you would like to receive text notifications for upcoming events, text @AllStateY to 81010.