This form must be completed for each delegate, either by the delegate or by their local cooperative. Local cooperatives must guarantee each delegate has no scheduling conflicts for June 14-20, 2025. Delegate Information Local cooperative name Delegate's first name Delegate's last name Nickname Name you want on your name tag Confirm delegate has no scheduling conflicts for June 14-20, 2026. True False Attach an original headshot. Please do not upload a scanned photo as they do not print well. Headshots can be taken with a cell phone, but must be taken from the shoulders up, and will be used for printing and on social media, so it must be high resolution.One file only.20 MB limit.Allowed types: gif, jpg, png. Delegate's phone number This will be used during Youth Tour Delegate's email address Non-school email Address City State Zip Code Delegate's date of birth Delegate's class rank Sophomore Junior Was the delegate a referral from a non-sibling 2025 Youth Tour delegate? Yes No If yes, please enter the name of the 2025 Youth Tour delegate who referred you. Parent/Guardian 1 Contact Information Parent/Guardian Contact 1 Full name Email address Phone number Parent/Guardian 2 Contact Information Must have a different phone number and email address than parent/guardian #1 Parent/Guardian Contact 2 Full name Email address Phone number Emergency Contact Information (non-parent/guardian) One non-parent/guardian emergency contact Full name Phone number Relationship Cannot be parents listed above Other Information Delegate's United States Congressional Representative Click here to determine delegate's congressional representative. Polos and t-shirts will be provided to each delegate. Polo shirts are NOT unisex. Please select polo type below. Men's Ladies' (fitted) Please select polo size Small Medium Large X-Large XX-Large Please select UNISEX t-shirt size Small Medium Large X-Large XX-Large CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
