World Affairs Institute for Student Leaders - Student Delegate Registration Form
The World Affairs Institute for Student Leaders is a community service project of Rotary International and World Affairs Council of Pittsburgh.

Please complete the form below by Tuesday, November 5.
Email address *
First and Last Name *
Your answer
High School *
Your answer
Grade *
Name of Rotary Club or School District providing scholarship *
Provide the name of the Rotary Club or School District providing your scholarship. If you received a scholarship from the World Affairs Council of Pittsburgh, please write, "Global Leadership Certificate". If you did not receive a scholarship, please write, "Individual Student Registrant".
Your answer
Dietary Restrictions
Your answer
Parent/Guardian Name *
Your answer
Parent/Guardian Cell Phone *
Your answer
Parent/Guardian Email *
This cannot be the same email entered in the first response field.
Your answer
Within 2 business days of submitting this form, you and the parent/guardian listed above will receive via email a Liability Release & Media Waiver requiring your e-signature. You must e-sign and submit the Liability Release & Media Waiver by Friday, November 1. *
Required
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