2017 Youth and Government Registration
Welcome to the STATE YMCA OF MAINE'S YOUTH AND GOVERNMENT PROGRAM. Complete this form and you will receive a confirmation email, and program information within the next few days.
You are the most important part of our program please make sure all of the information is correct.
Email address *
First Name *
Name you want to appear in publications and on name tag
Your answer
Last Name *
Your answer
Grade *
How many years have you participated in YAG *
School or Delegation *
Your answer
Home Address *
Your answer
Home Town *
Your answer
Zip Code *
Your answer
Your email address *
Your answer
Best Phone # to reach you *
Your answer
Any medications or medical issues we should know about
Your answer
Which committee would you most like to be assigned to ?
Which committee would you be your 2nd choice like to be assigned to ?
Which committee would you be your 3rd choice like to be assigned to ?
I have read the Code of Conduct and the Dress Code and Understand and accept that I will follow these in order to participate *
Required
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