Central Indiana Youth Convention Registration
For ages 10-28. Fill out and submit this form to receive a free 2023 Youth Convention shirt. 
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First Name:  *
Last Name:  *
Age: *
Gender: *
Shirt Size: *
Address: *
City:  *
State: *
Zip: *
Cell Phone Number:
Email Address:  *
Emergency Contact Name: *
Emergency Contact Phone Number: *
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