2024 Key Leader Conference
May 17-19, 2024

Fields outlined in red are required.
First Name:		Last Name:
Email:
Nickname for Badge:
Student or Student Facilitator?	StudentStudent Facilitator	Been to a Key Leader Event Before?	YesNo
Street:		City:
State:		Zip:
Home Phone:		Other Phone:
Name of School:		Date of Birth:
Year in School:	89101112	Gender:	Female/FeminineMale/MasculineGender Non-Binary
How did you hear about Key Leader?	Key Club/Kiwanis ClubPrincipal/Counselor/TeacherFFANational Student Council ConveParent/GuardianOther	How heard, if Other:
Are you a member of:	Key ClubBuilders ClubNeither	Sponsoring Kiwanis Club (if applicable):
Sponsor name:*		Sponsor email:
Sponsor Phone:
Additional Sponsor Name:**		Addtional Sponsor Email:
Additional Sponsor Phone:
Do you have any special needs (dietary or physical)?
Emergency Contact Name:		Emergency Contact Phone:
Emergency Contact Relationship to Student:
	Type number at right into box:
* Sponsor Name - this is the person or organization that will provide FUNDING for your participation in Key Leader Weekend. (Example: Kiwanis Club, School, Parent)
** Additional Sponsor - this is the person or organization that will be providing additional funding for your participation in the Key Leader weekend (if applicable).

When you've completed the form, click on the Next Step button.