Maritime Youth Leadership Ambassador of Wilmington Interest Form

Please complete the form below if you are interested in the Los Angeles Maritime Institute's Maritime Youth Leadership Ambassadors of Wilmington, and we will contact you about an upcoming session.

Complete la forma abajo si está interesado en el programa de Los Embajadores de Liderazgo Juvenil Marítimo de Wilmington del Instituto Marítimo de Los Ángeles, y nos comunicaremos con usted sobre una próxima sesión.

This unique program – open to youth ages 12-18 who reside in or attend school in Wilmington – gives participants an opportunity to learn about sailing, marine ecology, maritime careers and vocations, and most importantly, themselves. They will develop their leadership and problem-solving skills, while interacting with each other and the world around them at sea and in nature through three sail sessions, followed by a three-day, weekend voyage to Catalina. The program is offered free of charge. Learn more at lamitopsail.org/myla.

This program is funded by the Outdoor Equity Grants Program, created through AB 209 and administered by California State Parks, Office of Grants, and Local Services.

Questions? Please contact Jemma Kennedy at 310.833.6055 or jemma@lamitopsail.org.

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Email *
Student's First Name:
Nombre de Estudiante:

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Student's Last Name:
Apellido de Estudiante:
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Student's Date of Birth:
Fecha de Nacimiento:

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Student Gender/ Género Del Estudiante *
Parent/Guardian First Name:
Nombre Del Padre/Tutor:
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Parent/Guardian Last Name:
Apellido Del Padre/Tutor:
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Parent/Guardian Phone Number:
Número De Teléfono Del Padre/Tutor:
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Student's School/Community Based Organization/Program Name:
Nombre de Escuela/ Centro Communitaro/Programa:
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Student's School or Home Address:
Domicilio de Escuela o Casa:
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Which Group(s) are you interested in?
¿A qué grupos te gustaría inscribirte?
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Required
Is there anything else you would like us to know about yourself or your student?
¿Hay algo más que le gustaría que sepamos sobre usted o su estudiante?
Thank you for your interest!
¡Gracias por interés!
The email used to sign up will be the one receiving updates/further information on our program. This information will be used only to track attendance, identify head count for transportation, gear, provisioning, and any other material that is needed for this program.

El correo electrónico utilizado para registrarse será el que recibirá actualizaciones/más información sobre nuestro programa. Su información se utilizará solo para realizar un seguimiento de la asistencia, identificar el recuento de personas para el transporte, equipo, avituallamiento y cualquier otro material que sea necesario para este programa.
A copy of your responses will be emailed to the address you provided.
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