New Member Application
Primary Account Holder
First Name
Middle Name
Last Name
Relationship to Youth
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Mother
Father
Caregiver
Suffix
Home Phone
Work Phone
Mobile Phone
Email
Occupation
Committee Preference
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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
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Coaching
Communications / Marketing
Finance
Membership
Philanthropy
Home Address (if different)
Street
City
Zip
Children
Child 1
Middle Name
Last Name
DOB
Current Grade
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3
4
5
6
7
8
9
10
11
12
School
Email
Child 2
First Name
Middle Name
Last Name
DOB
Current Grade
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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.
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Yes
No
Requirements
Digital Signature
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