YGPA Leadership Conference Registration

Please fill out all information for the adult attending.
1.First Name(Required.)
2.Last Name(Required.)
3.Your YMCA(Required.)
4.Your State(Required.)
5.Your Job Title or Role(Required.)
6.I am registering as:(Required.)
7.Number of Years with Youth and Government or the YMCA?(Required.)
8.Your Email(Required.)
9.Cell Phone Number(Required.)
10.Gender
11.Your Correct Pronouns
12.Shirt Size(Required.)
13.Emergency Contact First Name ?(Required.)
14.Emergency Contact Last Name ?(Required.)
15.Emergency Contact Best Phone Number ?(Required.)
16.List any allergies (Dietary/Medicinal/Environmental/etc...) ?
17.Meal Requests-Please indicate if a specific meal type is requested
18.Other Dietary Requests or Restrictions ?
19.Please let us know of any requests, ideas, or goals you have for the conference .