Confirmation

We’ve received your interest form and will be in touch soon. If you would like to reserve your spot, please register below to pay your $500 non-refundable deposit to secure the room.

Price:

$500

First Name: First Name Required

Last Name: Last Name Required

Address Line 1:* Address Line 1 is Required

Address Line 2: Address Line 2 is not valid

City:* City is Required

Country:* Country is Required

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State/Province:* State/Province is Required

Zip/Postal Code:* Zip/Postal Code is Required

Address (Street):* Address (Street) is Required

City:* City is Required

State:* State is Required

Cell Phone Number:* Cell Phone Number is Required

Age:* Age is Required

Food Allergies: Food Allergies is not valid

Bed/Room Options:* Bed/Room Options is Required

Downstairs Bedroom #1 = 3 Queen beds Downstairs Bedroom #2 = 1 King bed Downstairs Bedroom #3 = 1 Queen bed, 1 twin bed Upstairs Bedroom #4 = 1 Queen bed, 1 twin bed Upstairs Bedroom #5 = 2 Twin beds

Which bed would you prefer in the bedroom you specified?:* Which bed would you prefer in the bedroom you specified? is Required

Anything additional you would like to share: Anything additional you would like to share is not valid

Instagram: Instagram is not valid

School:* School is Required

Grade:* Grade is Required

Will you need bus transportation?:* Will you need bus transportation? is Required

NoYes

T-Shirt Size:* T-Shirt Size is Required

SMLXL2XL3XL

What clubs or organizations are you involved in at school?:* What clubs or organizations are you involved in at school? is Required

Do you have any leadership positions in those organizations?:* Do you have any leadership positions in those organizations? is Required

Do you play any sports? If so, what sports do you play?: Do you play any sports? If so, what sports do you play? is not valid

Why do you want to participate in The Young Leaders of Decatur Conference?:* Why do you want to participate in The Young Leaders of Decatur Conference? is Required

YesNo

What is your favorite subject?:* What is your favorite subject? is Required

Who is your favorite leader and why?:* Who is your favorite leader and why? is Required

What are your aspirations for after high school?: What are your aspirations for after high school? is not valid

What is your favorite thing about yourself?:* What is your favorite thing about yourself? is Required

What is one thing you’d like to change about yourself?:* What is one thing you’d like to change about yourself? is Required

Do you agree to accept text messages from Durbin Leadership with details about the conference?:* Do you agree to accept text messages from Durbin Leadership with details about the conference? is Required

YesNo

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