2017 Eastern Regional Summit Application
Thank you for your interest in attending the 2017 Eastern Native Youth in Food & Agriculture Regional Summit! The review committee looks forward to receiving your application and learning more about your interest in food and agriculture. You should submit your entire completed application and supplemental materials no later than 11:59 PM EST on May 15, 2017. For all questions, please contact Kelsey at kelsey@indianaglink.com.
First Name
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Last Name
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Age
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Date of Birth
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Tribal Affiliation
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Mailing Address Line 1
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Mailing Address City
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Mailing Address State
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Mailing Address Zip Code
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E-mail Address (Please use a personal e-mail address, and not that of a teacher/parent/etc. We will utilize this form of communication the most, so make sure it is an account you'll have access to!)
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Confirm E-mail Address
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Cell Phone
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Home Phone
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Gender
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Adult T-Shirt Size (XS, S, M, etc.)
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Preferred method of contact?
What social media outlets do you use? (Select all that apply)
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