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PDPW Youth Leadership Derby

Registration Form

Note: Fill in the registration form below, carefully review your entries, and then click the "Register Now" button. Click here to view our terms and conditions.

Fields with (*) are required.

*Name(s) of Attendees:
Full Name: (if different than above)
*Farm or Business Name:
*Email Address:
Number Of Attendees ($89/student (open to public, including non-members and non-farm students)
Parents Name(s)

Parent Address, City, State, Zip

Emergency Phone

Parent Email

Student Email

Student Age

Student T-Shirt Size

Student allergies

Registrant Comments: (250 characters maximum)

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