YUGA Group Registration Form

Please fill in the information below regarding your YUGA group. * required fields
Is this a School Group? *	Yes No
If this is a school group:
School Name:
School Address:
School City:
School State:
School Zip Code:
School Phone:
Group Information:
Group Name: *
Group meets:
Goals of the group:	(i.e. show a film on World AIDS Day to raise awareness about this issue):
Group Leader Name: *
Group Leader Email: *
Group Leader Phone: *
Group Leader 2 Name:
Group Leader 2 Email:
Group Leader 2 Phone:
Group Adult Facilitator Name:
Group Adult Facilitator Email:
Group Adult Facilitator Phone:
Facilitator Relationship:
Member Information:

Member Names	Member Emails	Member Phones









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