2019 Washington Youth Tour Electric Cooperatives of Arkansas

Personal Data Form

U.S. Citizen

Gender

T-shirt Size

Photos: We need a portrait photograph of you for our delegate directory. It can be a hard copy or a digital photograph. (di gitals are preferred). (Please check one)

Identification : We also need a photocopy /scan of your driver’s license or official state identification. This can be a hard copy or emailed. (Please check)

Medical Insurance card ( only if you have medical insurance ) : We need a photocopy of your medical insurance card or a scanned copy can be emailed. (Please check)