(* denotes required field)
First Name:
*
Last Name:
*
E-Mail Address:
*
Phone Number:
*
Grade level (now):
*
Gender:
Select
Male
Female
*
Birthday:
*
Address:
*
City:
*
State:
*
Zip:
*
Parents First and Last Names:
*
Parents Phone Number:
Day:
* Evening:
*
Parents Email:
*
Which workshop are you interested in?
Make Selection
Policy Project
Sophomore Project
Fast Track
Advocacy Skills in Action
*
Previous Institutes:
2004:
2005:
2006:
Previous Instructors:
2004:
2005:
2006:
Roommate Request:
Dietary Restrictions?
High School Name:
*
High School Address:
*
High School City:
*
High School State:
*
High School Zip:
*
Coach Name:
Coach's Email:
Coach's Phone:
Number of Tournaments Attended?
2004:
2005:
2006:
Total debates participated in?
*
Will you be requesting financial aid?
Yes,
No
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