College Issues Forum Registration Form

Missouri YMCA Youth In Government: College Issues Forum Registration Form

The College Issues Forum Registration Form must be completed by March 12, 2010.

If you have any questions about or trouble with the form, please contact us at yig@jcymca.org.
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Student Information
Please enter the following information to register for CIF. Your PREFERRED NAME will be used on your nametag at CIF.

Prior YIG Participant?	Yes No
Name (First, Preferred, Last):
Example:	Abraham, Abe, Lincoln
Sex:	Male Female
Date of Birth:	(Example: 06/25/2003)
High School Grad Year:
College/University:
Major:

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

Address:
Phone Numbers - Home:	Cell:
Can YIG send you text messages?	Yes No
Email:

Emergency Contact Information
Please enter emergency contact information for you.

Name:
Relationship to you:
Phone Numbers - Home:	Cell: Work:
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Name:
Relationship to you:
Phone Numbers - Home:	Cell: Work:

Leadership Role
Are you interested in serving in a leadership role at CIF? We will have opportunities for students to serve as Committee Chairpersons and Presiding Officers. Please indicate your interest below. There will be a separate application for these roles after the registration deadline.

Leadership Role:

Yes, I am interested in a leadership role. No, I am not interested.

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