If there are special needs / requests for this registration (such as dietary needs, hotel room requests, etc), please provide information below. We will do our best to accommodate special needs / requests as we are able. We may need to contact you for additional information.

In case of emergency, I understand that every effort will be made to contact the parent or guardian of the person named herein. In the event I cannot be reached, I hereby give permission to the physician selected by the conference director to hospitalize and secure prompt treatment for, and order injection or anesthesia or surgery for my child as named herein. I also affirm that the medical information on this form is complete and correct.

As a delegate participating in the NWYC, I agree to follow the guidelines given for this event and will respect the leadership while attending the NWYC. I understand that if I choose not to follow these guidelines, the consequences may result in my being sent home at my parent's/guardian's expense. Checking the box below confirms my commitment.