REGISTER: CONFIDENCE CLINICSFully complete the form below to reserve your spot at the upcoming Confidence Clinic! Student's Name* First Last Parent/Guardian Name* First Last Best Email to Contact Parent/Guardian* Parent/Guardian Cell #*Student's Date of Birth* Name of Student's School* Year Student is Expected to Graduate High School* Mailing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Student's T-Shirt Size (unisex - adult sizes only)* S M L XL Lead Group Coach or Location (type N/A if not in a Lead Group)* Select the Clinic(s) You are Registering to Attend* 4/17 CONFIDENCE CLINIC 4/24 CONFIDENCE CLINIC 5/1 CONFIDENCE CLINIC 5/8 CONFIDENCE CLINIC Today's Total $0.00 Δ JOIN A LEAD GROUPSee All Girls Live With The Courage To LeadLove Progress Park is Empowering and Equipping People Throughout the World to Realize their Fullest Potential and Inspire Others
