Clarksdale Youth Led Healing and Change Registration Form
Register to be a part of Clarksdale youth led community healing and social change.
First Meeting:
April 1, 2023 1PM
Crossroads Cultural Arts Center
332 Delta Avenue

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Email *
Name *
Age *
Address *
Phone number *
School Attending (if any)
Emergency Contact Name and Phone Number *
Will you be attending the first meeting?
Why are you interested in healing and social change? Please share briefly about your interest in this program. There is no right or wrong answer.  Thank you.
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