2010 Final Summit Student Registration (2)

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2010 SA Youth Summit Student Registration

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2010 Final Summit Student Registration (2)

  1. 1. Student Registration Roster Please print or type name clearly School Name: _____________________________ School Representative: ______________________ School’s Council District: __________ Contact # for Day of Event: ___________________ # #Student NameGrade #Student NameGrade 1 2 2 2 3 2 4 2 5 3 6 3 7 3 8 3 9 3 10 35 11 36 12 37 13 38 14 39 15 40 16 41 17 42 18 43 19 44 20 45 21 46 22 47 23 48 24 49 25 50 N 126 227 328 429 530 631 732 833 934 1 3 1 3 1 3 1 3 1 3 1 4 1 4 1 4 1 4 1 4 2 4 2 4 2 4 2 4 2 4 2 5 Office Use Only: Date Received: ___/___/___ Form Entered: ___/___/___
  2. 2. School Questionnaire School Name: ______________________________________________________________________________ School Rep: _______________________________________________________________________________ Are any student organizations represented in your group? If so, which ones? _________________________________________________________________________________________ _ _________________________________________________________________________________________ _ _________________________________________________________________________________________ _ How were students selected to participate? _________________________________________________________________________________________ _ _________________________________________________________________________________________ _ _________________________________________________________________________________________ _ Please fax this form to at 210-918-5628 If you have any further questions regarding how to fill out this form call 210-918-2215 or 210-207-1338 Thank you and we look forward to seeing you there! Office Use Only: Date Received: ___/___/___ Form Entered: ___/___/___

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