Adult Registration Form

Missouri YMCA Youth In Government: Adult Registration Form

Please complete the Adult Registration Form by October 13, 2011.

If you have any questions about or trouble with the form, please contact Ken Hussey at khussey@jcymca.org.
All adults must complete the Adult Participation Agreement and Medical Forms, and submit to their Delegation Director.
All advisors are asked to indicate their preference for assignments at the State Convention. All advisors work within a program area or another assignment. Without the hard work of advisors, the program could not function.
Please note that this form works best when JavaScript is enabled.

Adult Information: Please enter the following information. Your PREFERRED NAME will be used on your nametag.

Are you a prior YIG Advisor?	Yes No
Title:
Name - First:	Preferred: Last:
Example:	Abraham, Abe, Lincoln
Sex:	Male Female
T-Shirt Size:
Delegation:	If not listed, please contact the YIG State Office.

Contact Information: Please enter accurate information so YIG can keep in contact with you about the program.

Address - Street:	City: State: Zip:
Phone Numbers - Home:	Cell: Work:
Can YIG send you text messages?	Yes No
Email:

Role Preference: All adult advisors will take on some role at the State Convention. You are asked to select your top three program choices. One option is Hotel. These advisors will primarily work in the evening and night at the hotel, serving as chaperones, hall monitors, and assisting with other facility needs. Hotel Advisors will be expected to remain up later in the night, but do not have a program assignment during the day.

1st Choice:
2nd Choice:
3rd Choice:

Terms of Agreement: Please review the following statement and indicate your agreement.

I have reviewed the Adult Participation Agreement. I agree to abide by all the rules and requirements set forth by Missouri YMCA Youth In Government.
Please check the box indicating that you have read and agree with the above statement. Your registration will not be accepted without checking this box.

Verification (CAPTCHA): Please enter the two words you see in the box below to securely submit your form.

Home - Contact Us - Forms & Applications - Key Dates & Deadlines - Program Documents