YUGA Leadership Camp Registration Form

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Join us this summer at the YUGA Leadership Camp 2009, July 18-24, 2010 at Camp Aldersgate in North Scituate, RI. Application deadline is April 30, 2010. * required fields
YOUR INFORMATION
Your Name: *
Your Date of Birth: *	(mm/dd/yyyy)
Your Gender: *	Male Female
Your Address: *

Your City: *
Your State: *
Your Zip Code: *
Your Home Phone: *
Your Cell Phone: *
Your Email Address: *
PARENT/GUARDIAN INFORMATION
Parent/Guardian Name: *
Parent/Guardian Email: *
Parent/Guardian Phone: *
ADVISOR and SCHOOL INFORMATION
Advisor Name: *
Advisor Email: *
Advisor Phone: *
Your School Name: *
Your School Address: *
Your School City: *
Your School State: *
Your School Zip Code: *
OTHER INFORMATION
What is your T-Shirt size? *	S M L XL
Your Primary Language: *
Other Languages you speak:	(other than English)
Have you studied, lived or traveled abroad? *	Yes No
If yes, where?
1. How did you hear about YUGA Leadership Camp? *

2. Please describe your involvement in any clubs or committees at your school or in your community. *

3. Please describe any experience you have with global issues or awareness raising. *

4. What are your personal goals for attending YUGA Camp and becoming a YUGA Leader? *

5. How will you contribute to the mission of YUGA? *

6. How will you start a YUGA chapter or implement YUGA Campaigns upon your return home? *

7. What strengths do you think you can bring to the YUGA Leadership Camp? *


Statement of Committment If I am selected to participate in the YUGA Leadership Camp, I agree to: Start a YUGA Chapter in my school or join an international club and run 3 YUGA Campaigns a year. Find an advisor in my school who can support my campaigns and activities. Communicate to Plan Staff at least 5 times a year to report on activities I am doing. By filling out and submitting this form you are agreeing to the above and certify that all information on the form is correct. If you are under 18 you are acknowledging that you have permission from a parent or guardian to participate in the 2009 YUGA Leadership Camp and that the cost for the camp is $250 USD.

After completing this form please click the submit button. You can also print this page and mail it to: Plan USA \| Attn: YUGA Leadership Camp \| 155 Plan Way \| Warwick, RI 02886