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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:


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?


Preferred mailing address for Wake Information: