Youth Leadership Conference - Registration
Event Dates: July 8-12, 2019
Event Address: Museum of the Albemarle, Elizabeth City NC
Contact us at (252) 562-4337 or iEmpowerNC@gmail.com
Youth Name (rising 5th-10 graders) *
School & Grade Level *
Parent/Guardian Name *
Parent/Guardian Phone Number *
Parent Email *
Youth's T-Shirt Size *
Food Allergies (if yes, please list them) *
How did you hear about the event?
I acknowledge that additional consents/paperwork will be required before my child can participate in this event. (Additional information will be provided closer to the dates of the event.) *
Required
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