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Missouri YMCA Youth In Government: Student Registration Form
The Student Registration Form must be completed by September 29, 2011.
  • All students must complete the Student Registration Form to participate in the YIG Model Government Program.
  • If you have any questions about or trouble with the form, please contact Ken Hussey at khussey@jcymca.org.
  • You must be in a delegation and complete all required fields to register for the program.
  • You also must turn in the Student Participation Agreement Signature Page and Medical Form to your delegation director.
  • Please note that this form works best when JavaScript is enabled.

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

Are you a prior YIG Participant?
  
Student Name - First:
   Preferred:    Last:
Example:
Abraham, Abe, Lincoln
Sex:
  
Date of Birth:
  (Example: 06/25/2003)
High School Grad Year:
      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:
Can YIG send you text messages?
  
Email:

Parent/Guardian Information: Please enter emergency contact information for you.

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

Program Area: Please select the Program Area you plan to participate in at the State Convention.

For Judicial participants, you are selecting your role preference for the Moot Trial competition at the State Convention, not your role for the case you are working on prior to the convention.

To participate in the Executive Branch, you must have been elected to an executive office at the previous State Convention, or been selected to serve as an assistant or staff member by an executive officer.
  
  

Running for Office: Are you currently a junior, with one year of experience in YIG? If so, you are eligible to run for office. If you are interested in running for office, please select which one below. This does not register you officially to run for this office. It simply provides the State Office with your indication of interest in running for office.

Office:

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

I have reviewed the Student Participation Agreement. I agree to abide by all the rules and requirements set forth by Missouri YMCA Youth In Government.

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






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