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Teen Summit Registration Kansas City Mo.
Participants can be male or female and must be age 10-19. Everyone involved with this Summit must fill out an application.
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Email
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Your email
Topic
Our Topics for the Midwest Tour are: Family, Leadership, Entrepreneurship, Finances and Violence.
General Information
Participants Name
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Your answer
Parent Name
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Your answer
Birthdate:
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MM
/
DD
/
YYYY
Address:
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Your answer
City & State
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Your answer
Zip Code
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Your answer
Phone Number
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Your answer
Emergency Contact Number
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Your answer
Parent Email
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Your answer
Additional Information
Organization:
Your answer
School:
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Your answer
Grade level:
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6-8th
9-12th
College
Interest
Hobbies
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Your answer
What topics interest you the most?
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Violence in your community
Family Values
Financial Future
Entrepreneurship
Required
Youth Leadership Ambassador
Please fill out the following question if you WOULD LIKE to be a Youth Leadership Ambassador.
If you DO NOT LIKE to be an Ambassador skip and add your Signature
What about your community would you like to change?
Your answer
DREAMS Leadership Ambassador Program (must be 12 & older)
Are you interested in mentoring youth?
Would you like to be on the Teen Summit Youth Panel?
Would you like to be a Committee Member for the Teen Summit ?
Would you like to Speak publicly to youth?
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Why should we choose you be a Leadership Ambassador?
Your answer
SIGNATURE
Signature
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