Your Information

1. First Name *
2. Last Name *
3. Middle Name
4. Name to be displayed on Nametag
5. Street Address *
6. City *
7. State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
8. Zip *
9. County
10. Home Phone *
11. Cell Phone
12. Email *

13. Gender

    Male Female
14. T-shirt Size * Small Medium Large XL XXL 3XL

Ethnicity Survey (optional)

1. What is your ethnicity?

   Hispanic or Latino Not Hispanic or Latino

2. Race

   American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White

School Info

1. School Name *
2. Current Grade * 8th Freshman Sophmore Junior Senior
3. GPA

4. Type of School

   Public Parochial/Faith Based Private Charter Home School Rural School

YEBW Background

1. Where did you first hear about YEBW?

   Parents School Friend Other

2. How?

   Presentation Teacher Facebook/Twitter Oregon Business Magazine Alumni TV/Radio Other
3. Alumni Name
4. TV/Radio Station

Program Registration

1. Select the program for which you are enrolling.

   1st Year: Business Week 2nd Year: Investment Week 3rd Year: Apprentice Week

2. Tuition

   I plan on applying for Financial Assistance. I would like to learn about fundraising opportunities.

Would you like to choose a roommate?

1. Roommate's Name
2. Roommate's Phone Number

Confirmation

1. I confirm that my parents/guardians have granted permission for me to complete this registration.
2. Parent Email *

Required Fields