Delegate Registration Form


Plese submit only one form per team member.

State:

Division: Please select an item.

State Director Email: A value is required.Invalid format.


First Name: A value is required.

Last Name: A value is required.

Pronouns: Please select an item.

Student Email: A value is required.Invalid format.

Cell Phone: A value is required.Invalid format.

Address: A value is required.

City: A value is required.

Zip: A value is required.Invalid format.

Please select an item.

Grade (in 2020-2021 school year): Please select an item.

Parent Name(s): A value is required.

Parent Email: A value is required.Invalid format.

I grant permission for photographs, written/art work, quotes, videos or other media to be used in media releases which benefit the YMCA Nationwide Judicial Conference.
I have been in contact with my State Director and understand my state's fee agreement.

 

By clicking the box below, all delegates listed on this registration form certify they will attend the Judicial Conference and agree to the Virtual Code of Conduct. Should any delegate choose to withdraw their registration after July 1, that delegate is responsible for their state's delegate fee or for finding a substitute.

We agree

You may need to wait up to 1 minute for your form to process, please do not click submit more than once.

Please note, the information contained in this form will be sent for verification to all of the email addresses (parent and student) provided in the form above.

After pressing submit, scroll up to see if you have incorrectly completed any fields (they will be highlighted in red)