YGPA Leadership Conference Registration
Please fill out all information for the adult attending.
OK
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1.
First Name
(Required.)
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2.
Last Name
(Required.)
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3.
Your YMCA
(Required.)
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4.
Your State
(Required.)
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5.
Your Job Title or Role
(Required.)
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6.
I am registering as:
(Required.)
YGPA Member
Youth and Government Volunteer
Alliance Staff/Director
Family/Friend of Attendee
Other (please specify)
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7.
Number of Years with Youth and Government or the YMCA?
(Required.)
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8.
Your Email
(Required.)
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9.
Cell Phone Number
(Required.)
10.
Gender
11.
Your Correct Pronouns
She/Her
He/Him
Them/They
Prefer not to answer (Nametag will omit this section)
Please type your correct pronouns below if not on the list above
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12.
Shirt Size
(Required.)
Small
Medium
Large
XL
2XL
3XL
4XL
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13.
Emergency Contact First Name ?
(Required.)
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14.
Emergency Contact Last Name ?
(Required.)
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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
Vegan
Vegetarian
Gluten Free
Nut Free
Lactose Free
Kosher
Halal
Other:
18.
Other Dietary Requests or Restrictions ?
19.
Please let us know of any requests, ideas, or goals you have for the conference .
