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Key Leader Event Registration
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* Indicates required question
Email
*
Your email
Registering as:
*
Choose
Participant
Student Facilitator
Adult Chaperone
Staff
Have you been to Key Leader before
*
No
Yes
First Name
*
Your answer
Last Name
*
Your answer
Home Address
*
Your answer
Home Address 2
Your answer
City
*
Your answer
State
*
Your answer
Zip
*
Your answer
Phone
*
Your answer
Email
*
Your answer
Gender
*
Female
Male
Birth Date
*
MM
/
DD
/
YYYY
T-Shirt Size
*
S
M
L
XL
XXL
XXXL
Any special dietary or physical needs
Your answer
School
*
Your answer
Are you a Member of:
*
Not a Member
Builder's Club
Key Club
Kiwanian
What year in school?
*
Freshman
Sophomore
Junior
Senior
Chaperone
Your sponsor belongs to:
Your answer
Sponsor First Name
Your answer
Sponsor Last Name
Your answer
Sponsor Email
Your answer
Sponsor Phone
Your answer
Emergency Contact Name
*
Your answer
Emergency Phone Number
*
Your answer
Relationship to Participant
*
Your answer
Emergency Contact email address
*
Your answer
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