U THE TEEN LEADER ENROLLMENT FORM Confirm Class Dates:*August 9-11, 2019October 4-6, 2019Prefix*Ms.Mr.Student Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Student Email* Student Phone*Student Age*Student Grade*Parent/Guardian Name* First Last Parent/Guardian Email* Parent/Guardian Phone*Second Parent/Guardian/Family Member Name* First Last Second Parent/Guardian/Family Member Email Second Parent/Guardian/Family Member Phone*Please note that parents/guardians/family members noted above will be considered emergency contacts. If neither of these people will be available during the training weekend, please reply to the enrollment confirmation with a backup contact name and phone number.Who referred you to U & Improved?*Refunds & Rescheduling Policy*I have read and agree to the terms of the Refunds & Rescheduling Policy.Refunds: We do not issue refunds. Please notify us within 14 business days if you need to reschedule your class date to avoid a rescheduling fee. Rescheduling: All classes are subject to a rescheduling fee of up to $350. To avoid the fee, please notify us within 14 business days of the class start date that you need to reschedule. This iframe contains the logic required to handle Ajax powered Gravity Forms.