WASHINGTON LEADERSHIP CONFERENCE
IOWA FFA GROUP--Week 3
REMEMBER: The Iowa WLC Group for Week 3 is June 18-23. The total registration cost is $900 per student and transportation is the responsibility of the student/chapter. SUBMITTING THIS FORM COMMITS THE MEMBER/CHAPTER TO THE REGISTRATION EXPENSES ASSOCIATED WITH THE TRIP. Invoicing will occur in late May. Please note that most of the information requested below is what is required on the National FFA registration that is submitted by the state. Please submit ONE form for EACH member. If the chapter is also planning to send a chaperon, please register them as well (complete the form for them individually) - Thank You!
Chapter Information
Boarding Location--Not Needed For Week 3
Chapter Name *
Your answer
Chapter ID (Ex: IA0412) *
Your answer
Advisor Name *
Your answer
Advisor Email *
Your answer
Advisor Cell Phone *
Your answer
FFA Member Information
Member First Name (ex: Jonathon) *
Your answer
Member Preferred Name (ex: John) *
Your answer
Member Last Name *
Your answer
FFA Membership ID (ex: 600812389) *
Your answer
Gender Identity *
Member's Address: State *
Member Mobile Phone Number *
Your answer
Member Email Address (type carefully!) *
Your answer
Polo Shirt Size *
T-Shirt Size (Unisex Sizing) *
Emergency Contact Information
Parent/Guardian Name (First & Last) *
Your answer
Parent/Guardian Email Address *
Your answer
Parent/Guardian Phone Number *
Your answer
Secondary Contact Person Name (First & Last) *
Your answer
Secondary Contact Person Phone Number *
Your answer
Other Information/Notes
ADA Information & Needs (Ex: Mobility, Vision, Hearing, Other)
Your answer
Food Allergies
Your answer
Other Special Notes
Your answer
Scholarship Recipient *
If National FFA Scholarship Recipient, enter scholarship code (Ex: ST312)
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Iowa FFA. Report Abuse