WASHINGTON LEADERSHIP CONFERENCE
IOWA FFA GROUP--Week 3
REMEMBER: The Iowa WLC Group for Week 3 is June 20-25. The total registration cost is $850 per student and transportation is the responsibility of the student/chapter. SUBMITTING THIS FORM COMMITS THE MEMBER/CHAPTER TO THE REGISTRATION EXPENSES ASSOCIATED WITH THE TRIP. Invoicing will occur in late May. Please note that most of the information requested below is what is required on the National FFA registration that is submitted by the state. Please submit ONE form for EACH member. If the chapter is also planning to send a chaperon, please register them as well (complete the form for them indivdiually) - Thank You!
Chapter Information
Boarding Location--Not Needed For Week 3
Chapter Name
Your answer
Chapter ID (Ex: IA0412)
Your answer
Advisor Name
Your answer
Advisor Email
Your answer
Advisor Cell Phone
Your answer
FFA Member Information
Member First Name (ex: Jonathon)
Your answer
Member Preferred Name (ex: John)
Your answer
Member Last Name
Your answer
Member's Address: State
FFA Membership ID (ex: 600812389)
Your answer
Member Email Address (type carefully!)
Your answer
Gender
Polo Shirt Size
T-Shirt Size (Unisex Sizing)
Member Cell Phone Number
Your answer
Emergency Contact Information
1st Emergency Contact Person Name
Your answer
1st Emergency Contact Person Number
Your answer
2nd Emergency Contact Person Name
Your answer
2nd Emergency Contact Person Number
Your answer
Other Information/Notes
ADA Information & Needs (Ex: Mobility, Vision, Hearing, Other)
Your answer
Food Allergies
Your answer
Other Special Notes
Your answer
Scholarship Recipient
If National FFA Scholarship Recipient, enter scholarship code (Ex: ST312)
Your answer
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