Video News Program Application

Please complete the following application to register for the Video News Program. 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 and Medical Form to your delegation advisor.

All program applications must be completed by September 19, 2007. If you have any questions about or trouble with the application, please contact Ken Hussey at khussey@jcymca.org.

Please note the following:

This form works best when JavaScript is enabled.
All items marked with an asterisk (*) must be filled out to complete your registration.

Student Information

* Have you participated in YIG before?	Yes No	Please enter all information. Please indicate if you have PARTICIPATED IN YIG before. This will assist with registering you for the program. Your PREFERRED NAME will be the name used in YIG correpsondence and on your name tag at the State Convention.
* First Name:
* Preferred Name:
* Last Name:
* Sex:	Male Female
* Date of Birth:	/ /
* High School Graduation Year:
* T-Shirt Size:

Warning: main(_contactinfo.php): failed to open stream: No such file or directory in /home/moyig/public_html/webforms/_mainform.php on line 6

Warning: main(): Failed opening '_contactinfo.php' for inclusion (include_path='.:/usr/local/lib/php') in /home/moyig/public_html/webforms/_mainform.php on line 6

Delegation Information

* Select Delegation:		Please select your DELEGATION from the drop-down menu. If your DELEGATION is not in the menu, please select "Not Listed" and type your delegation's name in the text box below the menu.
* Delegation:

Program Selection

* Program Area:

Please select your PROGRAM AREA. A new box will appear below with questions specific to your PROGRAM AREA. Please answer all questions.

Warning: main(_videorequire.php): failed to open stream: No such file or directory in /home/moyig/public_html/webforms/videonews.php on line 38

Warning: main(): Failed opening '_videorequire.php' for inclusion (include_path='.:/usr/local/lib/php') in /home/moyig/public_html/webforms/videonews.php on line 38

Fatal error: Call to undefined function: videorequire() in /home/moyig/public_html/webforms/videonews.php on line 41

* Moot Trial role in 2007:	Attorney Witness Judge None	Please select what role you had LAST YEAR (2007) in the MOOT TRIAL COMPETITION and your preference for THIS YEAR (2008).
* Moot Trial role preference for 2008:	Attorney Witness

Only single authors with at least one year of participation in the Legislative Program are permitted to serve in the Senate.	Senate	Please indicate which LEGISLATIVE CHAMBER you would prefer to serve in this year. This indicates your preference but does not guarantee you a spot in the specified chamber.
Both single authors and co-authors may serve in the House.	House
All freshmen and first year YIG participants must serve in the Novice House.	Novice House

Laptop:	Yes No	Please indicate if you have a LAPTOP or DIGITAL CAMERA that you can bring to and use at the State Convention.
Digital Camera:	Yes No

Camera:		Please indicate the type of equipment you have access to that you could use for YIG. If you have a camera, be sure to bring batteries and/or a battery charger for the camera.
Tripod:	Yes No
Hand-held Microphone:	Yes No

Issue 1:		You must select two ISSUES that you will represent as a lobbyist. Please review Issue Organizations list for ideas. Then, type the issue into the field.
Issue 2: