EmailMe Form - 2026 National Coin Week Youth Activity

Student Name *

First Last

Student Email

(If applicable.)

Student Grade *

Available to grades 9-12.

Are you an ANA member? *

Yes

No

Mailing Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

What is depicted on your coin? *

Description of your idea/why you chose your idea. *

Front (obverse) of coin image upload: *

Back (reverse) of coin image upload: *

Parental/Guardian Consent

By submitting this form, I confirm that I am the parent or legal guardian of the above-named child and give permission for my child’s information to be collected and used solely for the purpose of registering and coordinating participation in this program.

I understand that this information will be securely stored, will not be shared with third parties, and will be used in accordance with the organization’s privacy policy. I confirm that I am 18 years of age or older and authorized to provide this consent. *

I agree and provide consent