IOWA FFA WASHINGTON LEADERSHIP CONFERENCE BUS TRIP
REMEMBER: The Iowa WLC Bus Trip is June 17-23. The total registration cost is $1000: $712 student registration and $288 for travel. Payment or approved purchase order received are what is used to reserve the spot. Submit ONE form for EACH member - Thank You!
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CHAPTER INFORMATION
Boarding Location *
Chapter Name *
Chapter Number (Example: IA0310) *
Advisor's Name *
Advisor's Email Address *
Advisor School Phone *
Advisor's Cell Phone Number (xxx-xxx-xxxx) *
FFA MEMBER INFORMATION
FFA Membership Number *
First Name *
Last Name *
Home Mailing Address *
Member's Address: City *
Member's Address: State *
Member's Address: Zip Code *
Member's Address: Zip Code *
Member's Email Address *
Gender *
Home Phone Number (xxx-xxx-xxxx) *
Member's Cell Phone Number (xxx-xxx-xxxx) *
1st Emergency Contact Person (First & Last Name) *
1st Emergency Contact Person Phone Number (xxx-xxx-xxxx) *
2nd Emergency Contact Person (First & Last Name) *
2nd Emergency Contact Person Phone Number (xxx-xxx-xxxx) *
Local Media Publication Name *
Local Media Publication Contact Email *
Additional Comments: Special Needs, Arrangements, Etc.
PAYMENT INFORMATION
Scholarship Recipient *
If National FFA Scholarship Recipient, enter scholarship code:
Payment Method *
Purchase Order Payment
If paying by purchase order, please provide a purchase order number
Submit
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