2017 WEST KY Unified Champion Schools Youth Leadership SUMMIT Registration Form

Please complete for each person registering to attend:
School Name*
First name*
Last name*
E-mail Address*
Cell Phone*
Date of Birth*
County of Residence*
Grade Level
I am...*
Emergency Contact Name*
Emergency Phone*
Dietary Restrictions
Vegetarian
Gluten Free
Other
Comments:
"*" = Required Fields