Military Order of the World Wars (MOWW)
Arizona Youth Leadership Conference

APPLICATION

TO ATTEND THE MOWW ANNUAL YOUTH LEADERSHIP CONFERENCE (AZYLC) TO BE CONDUCTED AT MESA, AZ ON THE CAMPUS OF ASU POLYTECHNIC, 15-19 JUL 2014.
									           
Name	                                                                    AGE           SEX:  M    F  2013/14 GRADE:  10 or 11           
		First              Middle           Last			                Circle one	                             Circle one

Address								 (        ) 					 	Street/PO Box		City		State	Zip			Phone #

*E-Mail Address 											

Approval of Parent/Guardian						  Date 				
						Signature

Name of Parent/Guardian										 
				 First		MI		Last	(Please Print)

Approval of High School Instructor:  						  Date			
						Signature

	Name of High School, Counselor/Instructor’s name & Title, EMAIL and Phone Number

The following information will be used to assign you to rooms, and groups.  Please give as much data as possible.

•	Leadership positions you have held or now hold: 																																	 

•	Co-curricular/extra-curricular activities (sports, clubs, Pompom cheer, TA’s, NHS, etc:																																										

•	Short Term Goals: 											
(Use back of sheet if necessary)

•	Long Term Goals: 											
(Use back of sheet if necessary)

•	Where do you expect to be in 10 years? 								

* Student/Applicant Signature										
--------------------------------------------------------------------------------------------------------------------------------------------

Sponsoring MOWW Chapter____________________		Approval:  				
											Signature

		 Address			        	 Approving Official Title		       	           Phone