Leader Sign up

All fields indicated with star are required. Leader Personal Information
Name and Grade
Title: *
First Name: *
Last Name: *
Grade/Year: *
Are you considering being a 24 Hour Wake Leader next year?
Home Address Information
Phone Number: *
Email Address: *
Mailling Address 1: *
Mailing Address 2:
City: *
Province: *
Postal Code: *
Country:	Canada
This sign up is strictly for Canadian participants only.
Other Information
Please enter your age: *	If you are under 18 we would like to inform your parent(s) or guardians of your participation. Please enter their name and email address and we will send them a brief email.
Parent/Guardian First Name: *
Parent/Guardian Last Name: *
Parent/Guardian Email Address: *
Co-Leader Information
Please indicate your Alternate/Co-Leader:
Co-Leader Title:
Co-Leader First Name:
Co-Leader Last Name:
Phone Number:
Email Address:
24 Hour Wake Group Information
Wake Group Name: *
NOTE: Please do not use acronyms or short forms when indicating your group name.

Estimate the size of your Wake group:

Estimate the number of participants in your Wake group: *
What language do yo uwant your material sent in:

Wake Group Type:

Other:
Group/School Address:
Group Phone Number:
Mailing Address 1: *
Mailing Address 2:
City: *
Province: *
Postal Code: *
Wake Date *

Other (please specify):
How did you find out about this site?

Other:
Preferred mailing address for Wake Information: