Registration Fee Waiver Request

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Thank you for your interest in iEmpower's 2023 Youth Leadership Conference! Complete the following questions to request that the organization waive your $25 registration fee for each Young Leader in your household. An iEmpower, Inc. representative will follow-up with you via email within 48 hours of your request.

**This information is for waiver consideration only. This information will not be provided to third parties.

Parent/Caregiver First & Last name: *

Address: *

Phone Number: *

Email Address: *

# of People in Your Household: *

Provide the first & last names of your Young Leaders (rising 5th-9th graders interested in participating in the conference): *

Gross household income (before taxes): *

In the year prior to Covid-19, did your child(ren) receive free or reduced lunch? *

Yes

Does anyone in your household receive EBT or SNAP benefits? *

Yes

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