Youth Summit 2019 Registration Feminism Social Justice Youth Summit June 2019 Child's/Participant's Name* First Last Child's Age*Please enter a number from 5 to 17.Preferred pronoun/gender IDGrade Level*SchoolParent / guardian name* First Last Parent cell or contact number*Parent email* Child's Email Registration Fee This is a "pay what you can" amount. Suggested amount is $150. You can also enter "0" and pay upon arrival. Even if entering "0" you should complete this registration to reserve your spot.Signature*By signing here you are granting your consent for your child to participate in the workshop.Total $0.00 Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name Only required if paying online.PhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.