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QAF 2016 Youth Workshop Registration: Queering Selfies
Please note that SPACE is LIMITED. You will be contacted by email to confirm your registration.
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First name
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Last name
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Phone number
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Email
*
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Age as of June 2016
*
QAF Youth Workshops are for ages 24 years and under
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Medical information
Please list any allergies or medical problems we should be aware of.
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Emergency Contact Name and Phone Number
(For youth 17 and under emergency contact may be a parent/guardian)
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Questions/Comments
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I am a registrant at least 18 years of age, or am the parent/guardian of a registrant under 18 years of age, and I certify that the above information is true and accurate
Please Initial Here
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