Amplify Youth Registration

PRIDE Troupe 2008-2009 Registration Form

Student Name
Student E-mail
Address
City
State
Zip
School attending in 09-10
Grade entering in 09-10
Home Phone number
Student Cell Phone
Father's Name
Father's Cell Phone
Mother's Name
Mother's Cell Phone
Parents Email
Parents place of employment
Adult T Shirt Size









Pants Size







The following are a few essay-type questions about your interest in Amplify Youth. Every student applicant must fill out this section to be considered. Please put some thought into these answers and be as specific as possible. These should be answered by the student who is applying to be an Amplify Youth member.

Question 1
Question 2
Question 3
Question 4
Question 5
Will you attend retreat?





Payment Options

You can submit a payment in 2 different ways. Please read carefully, as the plans are different.

Payment by check:

1. $250 at once by July 16th
2. $150 initial payment by July 16th, followed by $100 payment by September 1st.

Payment by credit card via paypal:

1. $250 payment by July 16th.
22. $150 Initial payment by July 16th.

* $100 payment by September 1st.

To submit a payment via credit car, please click the links below or click on "Payments" on the left side navigation menu. Be sure to choose the correct option.

I am paying by credit card and choose:
I am paying by check and choose:

Please mail your checks to "Amplify Resources, 1776 Orleans Street, Mandeville, LA 70448". They must be postmarked by July 16th.

Please check here to agree to...

By checking the box below I acknowledge that I have read the above information thoroughly and have read and understand the participation requirements.

By checking this box I am also agreeing that I have shared this information with a parent or guardian and they have agreed to let me be a part of Amplify Youth and the organization, Amplify Resources.

Check here to acknowledge: