STAY Project Membership Form
This form is created to get updated information from current STAY members and for new STAY members to sign up!

The only criteria to becoming a STAY member is:
1. That you are between 14-30 years old.
2. You're a young person from Central Appalachia including Eastern Kentucky, Southwestern Virginia, Eastern Tennessee, West Virginia, and Western North Carolina.
Email address *
Last Name *
First Name *
Gender Pronouns *
Race/Ethnicity
Economic Class
Do you identify as LGBTQIA+?
(This is used for demographic tracking and will not be attached to your name)
Clear selection
Birthday *
MM
/
DD
/
YYYY
Phone Number
Current Location *
Home
Job/Affiliated Organizations/Clubs
Mailing Address
Anything else you want us to know about you?
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