New Member Application
Primary Account Holder
First Name
Middle Name
Last Name
Relationship to Youth
Select ...
Mother
Father
Caregiver
Suffix
Home Phone
Work Phone
Mobile Phone
Email
Occupation
Committee Preference
Select ...
Coaching
Communications / Marketing
Finance
Membership
Philanthropy
Home Address
Street
City
State
County
Zip
Secondary Account Holder
First Name
Middle Name
Last Name
Mobile Phone
Email
Occupation
Relationship to Youth
Company
Committee Preference
Select ...
Coaching
Communications / Marketing
Finance
Membership
Philanthropy
Home Address (if different)
Street
City
Zip
Children
Child 1
Middle Name
Last Name
DOB
Current Grade
Select ...
3
4
5
6
7
8
9
10
11
12
School
Email
Child 2
First Name
Middle Name
Last Name
DOB
Current Grade
Select ...
3
4
5
6
7
8
9
10
11
12
School
Email
Child 3
First Name
Middle Name
Last Name
DOB
Current Grade
Select ...
3
4
5
6
7
8
9
10
11
12
School
Email
Additional Information
Does your family qualify for free or reduced school lunches? * You may be eligible for a YCL scholarship to assist with your membership fee.
Select ...
Yes
No
Requirements
Digital Signature
You are not currently logged in. Please log in to submit this form.
Cancel