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2014 Youth Summit Registration!
The summit is FREE and open to all high school aged youth. Completing the form below is not required but will save you time on the day of the summit! For more information, visit the GLSEN Baltimore Facebook page.
Name
*
First
Last
Date of Birth
*
MM
/
DD
/
YYYY
School
*
Grade
*
9th
10th
11th
12th
Not attending (but under the age of 19, not in college)
Does your school have a Gay Straight Alliance or similar organization?
*
Yes and I'm involved
Yes but I'm not involved
No
No, and I want help starting one
Email
*
This will be for communication related to the summit ONLY unless you check the boxes below.
Please add me to the GLSEN Baltimore E-mail List
I am interested in receiving information about Youth Leadership opportunities
I am interested in receiving information about volunteering with GLSEN at local schools
Check all that apply
Other Optional Information
Please note this information will be collected at the summit. Feel free to fill it out now to save time later! The information provided will only be used in case of emergency at the summit.
Emergency Contact
First
Last
Emergency Contact Relation
Emergency Contact Phone
###
-
###
-
####
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