AYM Individual Registration
Saturday, November 10, 2018 at Pasadena City College
7:00 a.m. – 3:00 p.m.
Registration Deadline: Friday, October 12, 2018
Deadline may close at an earlier date

No refunds & No cancellations will be accepted after this date
**REMINDER: To complete your registration you must submit a purchase order or payment by Friday, October 12 at 5:00pm.**

CONFERENCE FEE: $25 / attendee

Please make check payable to Adelante Youth Alliance
Mail your check to:
Adelante Youth Alliance
P.O. Box 92517, Pasadena, CA 91109

**There is no online payment option.**

First Name of Student / Youth Attendee: *
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Last Name of Student / Youth Attendee: *
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Age: *
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Grade: *
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School or Organization:
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What is your school district
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City: *
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State/Province: *
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Home Phone: *
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Cell Phone:
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Email: *
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Name of Adult(s):
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City:
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State/Province:
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Home Phone:
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Cell Phone:
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Email:
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Total # of Attendees: *
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Comments:
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