4-H Spectacular Youth Leadership Institute

Staff Register Here

Required fields are indicated with an asterisk (*)

Registrant Information

* First Name

* Last Name

* Address

Addt'l Address

* City

* County

* State

* Zipcode

* Phone Number

* E-mail If you supply an e-mail address, a receipt for your registration will automatically be sent to that account. An e-mail address is required to pay using a credit card.

* Are you 21 years or older?

I will be serving as the chaperone for the following youth participants:

* What is your gender identity? (this information will be used only for the purpose of assigning overnight housing)

Registration Information

Registration * I would like to register for this event

Lodging options * I will utilize the standard lodging (double occupancy) for Friday and Saturday which is already included in the registration fee I would like to reserve a single occupancy room for Friday and Saturday I do not require overnight accommodations (full registration fee still applies)

Roommate Request If you do not select a roommate, a roommate will be assigned by gender selected below.

Please share any dietary needs, or requests, that you would like us to accomodate or be aware of::

Adult Demographics Information MSU Extension is interested to know more about who is attending programs to help identify potential gaps in audience reach. The following questions are optional to answer but we would appreciate any information you would be willing to give to help us understand more about our audiences served.

* Residence Type

* Age

Military Status * I am not serving/nor have I served in the military I am serving in the military I am a veteran Prefer not to state

* Branch and Component of Service

Contact Information

For more information, please contact Roxanne Turner, MSU Extension Educator, at 517-546-3950 or turnerr@msu.edu or Janelle Stewart, MSU Extension Educator, at 517-264-5307 or stewa191@msu.edu.