Youth first name
Youth last name
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Parent/Guardian Telephone Number
List up to 3 careers that currently interest you (one on each line):
TERM OF AGREEMENT: This event is offered free of charge to youth. If you register and don't attend, you could be charged a $50 cancelation fee.
By checking this box, I have read the above and accept this Term of Agreement.
How did you hear about this conference?
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