Delegate Payment Form

Student Delegate Registration Form [or download and send in the Word doc]

Date
Town/Ward
Chair
Female Student Delegate
Name:
Address:
School Name:
Year of Graduation
Parent/Guardian Name
Address:
Contact Phone Number:
Male Student Delegate
Name:
Address:
School Name:
Year of Graduation
Parent/Guardian Name
Address:
Contact Phone Number:
Delegate Chaperone
Name:
Address:
Cell Phone Number :
Elected delegate/alternae to 2008 DSC?	Yes No