Group Registration Form

Contact Name: *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do You Need An Invoice? *

Yes

No

Terms of Agreement 1.) One chaperone per every 10 students is required to accompany & supervise your students throughout conference day. 2.) Each chaperone is responsible that each of their students attend a workshop during each session, behave respectfully throughout the day. 3.) At least one certificated staff member must be responsible for the group, and provide AYA with that member’s contact info in case of emergency. 4.) Each certificated staff member must have emergency contact info for each of their attendees. 5.) Do not save seats in the workshops 6.) Do not leave the PCC campus during conference hours *

I agree to Terms of Agreement