Advisor Registration

If you need assistance with this form, please email YMCA NC Youth & Government Tech Support at support@ncyag.org

Personal Information:

Username:

Email Address:

Password:

Confirm Password:

First Name:

Last Name:

Date of Birth:

Gender:
MaleFemale

Home Address:

Home City:

Home Zip:

Home Phone:

Work Address:

Work City:

Work Zip:

Work phone:

Emergency Informaion:

Emergency Contact:

Emergency Contact Home Phone:

Emergency Contact Work Phone:

Health Issues, Medications, etc.:

Vegetarian?:
YesNo

Insurance Carrier:

Policy #:

School:

Please select your school for the list below. If your school is not listed, please select Not Listed and email support@ncyag.org

If you are an Advisor to more than one school, please select only 1 school from the list and email support@ncyag.org the other schools you are associated with.

School Advisor:

YMCA:

YMCA Phone:

YMCA Advisor:

Please Read and Verify:

Code of Conduct: As an advisor at the YMCA NC Youth Legislature, I will follow all rules and procedures, as found in my advisor’s manual. I acknowledge that I have read and understand the adult code of conduct found in the advisor’s manual. I understand that I am required to attend all events. I also understand that I represent my YMCA and my school and should act accordingly while at this conference.

I agree to follow the YMCA NC Youth Legislature Code of Conduct

Register

If you need assistance with this form, please email YMCA NC Youth & Government Tech Support at support@ncyag.org

Advisor Registration

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