2019 Young Man Encampment Registration Form

Date: July 21 to July 25 2019

Where: Mount Washington, New Hampshire

Download the two forms at the bottom of this form and fill them out and email to: thx2k3@gmail.com or send thru regular mail to:

Eliel Carvalho: 11 High Ridge Rd. Naugatuck, CT. 06770.

PS: You can also hand the filled out forms to you local Young Man President.

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth

MM

DD

YYYY

Email Address

Primary Phone

(###)

###

####

Ward

Parent / Guardian Name

First Name

Last Name

Parent / Guardian Email

Parent / Guardian Phone

(###)

###

####

Download Permission and Medical forms: Permision Slip.pdf