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.
First and Last Name
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".
Parent/Guardian Cell Phone
This cannot be the same email entered in the first response field.
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.
I have read and acknowledge the above statement.
Send me a copy of my responses.
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This form was created inside of World Affairs Council of Pittsburgh.