Pre-Registration Interest Form

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Event Timing: April 16th, 2026
Event Address: 17432 SE 392nd St Auburn WA 98092
Contact us at (509)907-7969 or yn@wayouth.us

Note this Year will be 100% in-person

We have 30–40 spots available for adults over 35 caregivers, families, and family organizations. All remaining spots will be designated for youth, youth peers, youth organizations, and those who serve youth. Thank you for your understanding.

Name *

Preferred Name

Email *

Pronouns *

Age range *

14-17

18-35

over 35

Are you a Certified Peer Support Specialist (CPSS) *

Yes

Do you work with Youth? *

Yes

I am a Youth

Other:

Will your program cover the cost for you to attend?
If not, please share what support or accommodations would help make your participation possible. *

Do you identify as a person with lived experience of mental health or substance use challenges? *

Yes

Prefer not to answer

Dietary restrictions *

Vegetarian

Vegan

Kosher

Gluten-free

Pregnant

Other:

Consent for photos and media *

I give permission to be photographed or recorded during the summit for documentation or promotional purposes.

I do not give permission to be photographed or recorded.

Required

ADA, any other questions about accommodation,

If you plan to attend with multiple people from your agency or with another individual, please indicate their name below, and ensure they fill out the pre-registration form.

I understand that I will have to pay $100 through the event registration form when received unless given an access code for a free ticket. *

Yes

Required

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