Athlete Leadership Conference Application
When: November 9th-10th 2018 (5pm Friday-4pm Saturday) Registration Closes: October 24, 2018 Where: Easter Seals Camp Sunnyside 401 NE 66th Ave Des Moines IA 50313
Speech Coach Name *
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Speech Coach Address *
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Speech Coach City *
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Speech Coach State
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Speech Coach Zip *
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Speech Coach Email Address
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Speech Coach Home Phone Number (Put NA if no land line phone) *
Your answer
Speech Coach Cell Phone Number (Put NA if no cell phone) *
Your answer
Speech Coach Shirt Size *
Birthdate of Applicant *
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DD
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YYYY
New Applicants- Provide a brief statement of your history with Special Olympics *
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Are you currently serving on a Special Olympics committee, as a coach, chaperone, etc. *
If you answered yes to the question above, please describe your current role
Your answer
List any dietary needs (Put NA if none) *
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I am a: *
List all the athletes you are a speech coach for *
Your answer
Best way to contact you for events (Check all that apply) *
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