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Students Lead Dayton 2019 - Registration
Student Name
*
First Name
Last Name
School
*
Grade Level in 2019-20
*
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Student Email
*
Verify Email
*
You may also list a parent email here to receive event details
Optional
Do you have a preferred name that you'd like to use for your nametag?
T-shirt Size
*
Small
Medium
Large
XL
XXL
Please list any dietary restrictions
Do you require any accomodations to be able to fully participate in this conference?
*
Yes, please contact me for more details
No, I do not need any accomodations
Emergency Contact - Name
*
Emergency Contact - Phone Number
*
Emergency Contact - Relationship to Student
*
Please select and continue to next page for payment
*
$30
-
Standard Registration
$0
-
Students Lead Dayton Scholarship Recipient
Add 3% to my total amount to help cover the payment processing fees