I am interested in: *

Mentoring (Ages 16 and Up)

Late Night Leadership Team (Ages 18 and Up)

Competitive Gaming & Tournaments

Branding and Graphic Design

Social Media Creator

Discord Monitor

Content Creation (Video, Program, Podcast)

Teaching or Speaking (Online or Onsite)

Event/Program Set up and/or Break Down

Other

Name *

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Last Name

Phone

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Personal Reference

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Organization's Phone

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Organization's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I certify that my answers are true and complete to the best of my knowledge

Yes