Youth Empowerment Summit Registration
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Email *
What is your name? *
Name of the Primary Project Contact *
If different from the person submitting this form, please enter the first and last name of the adult( over 18 years old) who will be the primary contact person for your organization's (or your personal) involvement in this project
Primary Project Contact - email address *
(if different from the one entered above)
What is the name of your organization? *
What is your organization's website (if one exists) *
Where are you located? Please enter your City/Town/Village *
Where are you located? Please enter your State/Province/Region *
Where are you located? Please enter your Country *
How many students do you anticipate will be involved in the project? *
What is the age range of the student(s) involved? *
When do you anticipate implementing the project? Check all that apply. *
Do you have budget monies available to support project involvement? (potential travel, tools, supplies, etc) If so, please let is know the approx allocation. *
Words Into Deeds, and all those with whom it partners, offers support for this project with the best of intentions and effort to create a lasting and positive impact for all involved. By submitting this form and agreeing to participate in this project, I acknowledge that in no case will Words Into Deeds, or any individual or organization supporting this project, be liable for any direct, indirect, incidental, special, exemplary, or consequential damages that may arise from participation by myself or any participants involved from my organization. *
A copy of your responses will be emailed to the address you provided.
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