Application Form - Leaders For Life Intl. At Hamilton College
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1leaders for life intl.
leaders for life intl.
leaders for life intl.
at Hamilton College
leaders for life intl.
at Hamilton College
at Hamilton College
high school overnight program - july 6 - july 11, 2014
at Hamilton College
high school overnight program - july 6 - july 11, 2014
high school overnight program - july 6 - july 11, 2014
high school overnight program - july 27 - aug. 1, 2014
high school overnight program - july 6 - july 11, 2014
HIGH SCHOOL OVERNIGHT PROGRAM: July 26 - 31, 2015
high school overnight program - july 27 - aug. 1, 2014
HIGH SCHOOL OVERNIGHT PROGRAM: JULY 16-21, 2017
high school overnight program - july 27 - aug. 1, 2014
HIGH SCHOOL OVERNIGHT PROGRAM: July 26 - 31, 2015
high school overnight program - july 27 - aug. 1, 2014
HIGH SCHOOL OVERNIGHT PROGRAM: JULY 23-28, 2017
applicant and parent or legal guardian (if applicant is under 18 years)
read, complete, and sign this form.
must
applicant and parent or legal guardian (if applicant is under 18 years)
read, complete, and sign this form.
applicant and parent or legal guardian (if applicant is under 18 years)
must
read, complete, and sign this form.
must
___________________________________________________________________
female
male
applicant and parent or legal guardian (if applicant is under 18 years)
read, complete, and sign this form.
must
___________________________________________________________________
female
male
a p p li ca n t ’ s n a m e : l a s t
___________________________________________________________________
f i r s t
female
male
___________________________________________________________________
female
male
a p p li ca n t ’ s n a m e : l a s t
f i r s t
a p p li ca n t ’ s n a m e : l a s t
f i r s t
_________________________________________________________________________ / ____ / _______
a p p li ca n t ’ s n a m e : l a s t
f i r s t
_________________________________________________________________________ / ____ / _______
_________________________________________________________________________ / ____ / _______
a p p li ca n t ’ s em a i l a d d r es s
dat e o f b i rt h : m o n t h
day
y e a r
a p p li ca n t ’ s em a i l a d d r es s
_________________________________________________________________________ / ____ / _______
dat e o f b i rt h : m o n t h
day
y e a r
a p p li ca n t ’ s em a i l a d d r es s
dat e o f b i rt h : m o n t h
day
y e a r
__________________________________________________________________________________________
a p p li ca n t ’ s em a i l a d d r es s
dat e o f b i rt h : m o n t h
day
y e a r
__________________________________________________________________________________________
__________________________________________________________________________________________
p r i m a ry s t r ee t a d d r es s
c i t y, s tat e , z i p, co u n t ry
__________________________________________________________________________________________
p r i m a ry s t r ee t a d d r es s
c i t y, s tat e , z i p, co u n t ry
p r i m a ry s t r ee t a d d r es s
c i t y, s tat e , z i p, co u n t ry
__________________________________________________________________________________________
p r i m a ry s t r ee t a d d r es s
c i t y, s tat e , z i p, co u n t ry
__________________________________________________________________________________________
__________________________________________________________________________________________
h o m e p h o n e
a p p li ca n t c ell p h o n e
h o m e p h o n e
__________________________________________________________________________________________
a p p li ca n t c ell p h o n e
h o m e p h o n e
a p p li ca n t c ell p h o n e
__________________________________________________________________________________________
h o m e p h o n e
a p p li ca n t c ell p h o n e
__________________________________________________________________________________________
__________________________________________________________________________________________
pa r en t / g ua r d i a n o n e : n a m e
p ro f es s i o n
wo r k o r c ell p h o n e
p r ef er r ed em a i l a d d r es s
__________________________________________________________________________________________
pa r en t / g ua r d i a n o n e : n a m e
p ro f es s i o n
wo r k o r c ell p h o n e
p r ef er r ed em a i l a d d r es s
pa r en t / g ua r d i a n o n e : n a m e
p ro f es s i o n
wo r k o r c ell p h o n e
p r ef er r ed em a i l a d d r es s
__________________________________________________________________________________________
pa r en t / g ua r d i a n o n e : n a m e
p ro f es s i o n
wo r k o r c ell p h o n e
p r ef er r ed em a i l a d d r es s
__________________________________________________________________________________________
__________________________________________________________________________________________
pa r en t / g ua r d i a n t wo : n a m e
p ro f es s i o n
wo r k o r c ell p h o n e
p r ef er r ed em a i l a d d r es s
__________________________________________________________________________________________
pa r en t / g ua r d i a n t wo : n a m e
p ro f es s i o n
wo r k o r c ell p h o n e
p r ef er r ed em a i l a d d r es s
pa r en t / g ua r d i a n t wo : n a m e
p ro f es s i o n
wo r k o r c ell p h o n e
p r ef er r ed em a i l a d d r es s
pa r en t / g ua r d i a n t wo : n a m e
p ro f es s i o n
wo r k o r c ell p h o n e
p r ef er r ed em a i l a d d r es s
leadership positions held (not required for attendance):
applicant tee shirt size:
applicant tee shirt size:
leadership positions held (not required for attendance):
youth large
applicant tee shirt size:
leadership positions held (not required for attendance):
__________________________________________________________________
youth large
adult small
leadership positions held (not required for attendance):
applicant tee shirt size:
youth large
__________________________________________________________________
adult small
adult medium
__________________________________________________________________
youth large
adult small
__________________________________________________________________
adult medium
adult large
__________________________________________________________________
adult small
adult medium
__________________________________________________________________
adult large
adult extra large
__________________________________________________________________
adult medium
adult large
adult extra large
__________________________________________________________________
adult large
adult extra large
adult extra large
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
s c h o o l i w i ll r ep r es en t
g r a d e en t er i n g s ep t em b er 2014
__________________________________________________________________________________________
s c h o o l i w i ll r ep r es en t
g r a d e en t er i n g s ep t em b er 2014
s c h o o l i w i ll r ep r es en t
g r a d e en t er i n g s ep t em b er 201 4
__________________________________________________________________________________________
s c h o o l i w i ll r ep r es en t
g r a d e en t er i n g s ep t em b er 201 4
__________________________________________________________________________________________
__________________________________________________________________________________________
s c h o o l a d d r es s
c i t y, s tat e , z i p, co u n t ry
s c h o o l p h o n e
__________________________________________________________________________________________
s c h o o l a d d r es s
c i t y, s tat e , z i p, co u n t ry
s c h o o l p h o n e
s c h o o l a d d r es s
c i t y, s tat e , z i p, co u n t ry
s c h o o l p h o n e
leaders for life intl.
__________________________________________________________________________________________
s c h o o l a d d r es s
c i t y, s tat e , z i p, co u n t ry
s c h o o l p h o n e
leaders for life intl.
leaders for life intl.
at Hamilton College
__________________________________________________________________________________________
__________________________________________________________________________________________
s c h o o l r ep r es en tat i v e : l a s t, f i r s t
r ep r es en tat i v e p h o n e
r ep r es en tat i v e em a i l a d d r es s
leaders for life intl.
at Hamilton College
at Hamilton College
__________________________________________________________________________________________
s c h o o l r ep r es en tat i v e : l a s t, f i r s t
r ep r es en tat i v e p h o n e
r ep r es en tat i v e em a i l a d d r es s
s c h o o l r ep r es en tat i v e : l a s t, f i r s t
r ep r es en tat i v e p h o n e
r ep r es en tat i v e em a i l a d d r es s
high school overnight program - july 6 - july 11, 2014
at Hamilton College
s c h o o l r ep r es en tat i v e : l a s t, f i r s t
r ep r es en tat i v e p h o n e
r ep r es en tat i v e em a i l a d d r es s
high school overnight program - july 6 - july 11, 2014
session i registration
high school overnight program - july 6 - july 11, 2014
:
by april
;
after april
*
$997
1
$1,297
1
high school overnight program - july 27 - aug. 1, 2014
if space is available
session i registration
:
by april
;
after april
*
HIGH SCHOOL OVERNIGHT PROGRAM: July 26 - 31, 2015
session i registration
high school overnight program - july 6 - july 11, 2014
HAMILTON SESSION: REGISTRATION $997 BY MAY 1; $1,297 AFTER MAY 1*
$997
1
$1,297
1
high school overnight program - july 27 - aug. 1, 2014
session ii registration:
high school overnight program - july 27 - aug. 1, 2014
:
by april
;
after april
if space is available
*
HAMILTON SESSIONS: REGISTRATION $997 BY JUNE 1; $1297 AFTER JUNE 1
(IF SPACE IS AVAILABLE)
$997
by april
1
;
$1,297
after april
1
*
$997
1
$1,297
1
if space is available
if space is available
session i registration
session ii registration:
:
by april
;
after april
*
by april
;
after april
*
HAMILTON SESSION: REGISTRATION $997 BY MAY 1; $1,297 AFTER MAY 1*
$997
1
$1,297
1
high school overnight program - july 27 - aug. 1, 2014
session ii registration:
if space is available
$997
1
$1,297
1
(IF SPACE IS AVAILABLE)
by april
;
after april
if space is available
*
$997
1
$1,297
1
if space is available
* First come, first served. No refunds will be granted, but a same-gender substitution can be made up to June 20.
r legal guardian (if applicant is under 18 years)
read, complete, and sign this form.
session ii registration:
must
by april
;
after april
*
$997
1
$1,297
1
if space is available
* First come, first served. No refunds will be granted, but a same-gender substitution can be made up to June 20.
r legal guardian (if applicant is under 18 years)
legal guardian (if applicant is under 18 years)
read, complete, and sign this form.
read, complete, and sign this form.
* First come, first served. No refunds will be granted, but a same-gender substitution can be made up to June 20.
must
must
mail form with
deposit to: leaders for life international, po box
, clinton, ny
________________________________________________
* First come, first served. No refunds will be granted, but a same-gender substitution can be made up to June 20.
female
male
$350
44
13323
legal guardian (if applicant is under 18 years)
read, complete, and sign this form.
must
mail form with
deposit to: leaders for life international, po box
, clinton, ny
________________________________________________
$350
female
male
44
13323
_______________________________________________
female
male
mail form with
deposit to: leaders for life international, po box
, clinton, ny
l July 26-21, 2017 Session
l July 23-28, 2017 Session
$350
f i r s t
44
13323
check #: ___________
check amount: ___________
CHECK #: ____________
CHECK AMOUNT: $_______________
mail form with
deposit to: leaders for life international, po box
, clinton, ny
_______________________________________________
$350
f i r s t
female
male
44
13323
f i r s t
check #: ___________
check amount: ___________
check #: ___________
check amount: ___________
(Please make deposit check payable to “Leaders for Life International,” or pay in full to “Trustees of Hamilton College”)
(Please make all checks payable to Trustees of Hamilton College.)
______________________________________________________ / ____ / _______
f i r s t
check #: ___________
check amount: ___________
(Please make deposit check payable to “Leaders for Life International,” or pay in full to “Trustees of Hamilton College”)
______________________________________________________ / ____ / _______
_____________________________________________________ / ____ / _______
(Please make deposit check payable to “Leaders for Life International,” or pay in full to “Trustees of Hamilton College”)
es s
dat e o f b i rt h : m o n t h
day
y e a r
__________________________________________________________________________________________
(Please make deposit check payable to “Leaders for Life International,” or pay in full to “Trustees of Hamilton College”)
es s
_____________________________________________________ / ____ / _______
dat e o f b i rt h : m o n t h
day
y e a r
s s
dat e o f b i rt h : m o n t h
day
y e a r
__________________________________________________________________________________________
_______________________________________________________________________
__________________________________________________________________________________________
c r ed i t ca r d #
s e c u r i t y co d e
ex p. dat e
s i g n at u r e
s s
dat e o f b i rt h : m o n t h
day
y e a r
__________________________________________________________________________________________
_______________________________________________________________________
c r ed i t ca r d #
s e c u r i t y co d e
ex p. dat e
s i g n at u r e
______________________________________________________________________
s
c r ed i t ca r d #
s e c u r i t y co d e
c i t y, s tat e , z i p, co u n t ry
ex p. dat e
s i g n at u r e
__________________________________________________________________________________________
c r ed i t ca r d #
s e c u r i t y co d e
ex p. dat e
s i g n at u r e
s
______________________________________________________________________
c i t y, s tat e , z i p, co u n t ry
c i t y, s tat e , z i p, co u n t ry
__________________________________________________________________________________________
__________________________________________________________________________________________
b i lli n g a d d r es s o n c r ed i t ca r d
_______________________________________________________________________
c i t y, s tat e , z i p, co u n t ry
__________________________________________________________________________________________
b i lli n g a d d r es s o n c r ed i t ca r d
b i lli n g a d d r es s o n c r ed i t ca r d
_______________________________________________________________________
______________________________________________________________________
a p p li ca n t c ell p h o n e
b i lli n g a d d r es s o n c r ed i t ca r d
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