Please complete the following questions.

* Denotes a required field

    ver 5.0.12

First Name *
Last Name *
Mailing Address *
City *
State *
Zip *
E-Mail address * (CRITICAL - your confirmation and packet will come via e-mail)
T-Shirt Size *	S M L XL XXL XXXL
What is your date of birth? * (MM/DD/YYYY)
Your Primary Phone Number * (area code) ###-####
Name of Parent/Guardian *
Parent/Guardian Home Phone * (area code) ###-#### (if no phone, enter "N/A")
Parent/Guardian Work Phone * (area code) ###-#### (if no phone, enter "N/A")
Parent/Guardian Cell Phone * (area code) ###-#### (if no phone, enter "N/A")
Parent/Guardian Address, City, State Zip *
In Case of Emergency (and parent/guardian is not available), Please Contact NAME *
In Case of Emergency (and parent/guardian is not available), Please Contact PHONE *
What is your religious affiliation (OPTIONAL)
What is the name of your hometown newspaper? *
What is the name of your high school? *

Please give the degree to which you agree or disagree with the following statements.
Respond using this scale: 1 - Strongly Agree 2 - Agree 3 - Disagree 4 - Strongly Disagree

The reduction of government bureaucracy is more important than preservation of the services it provides. *	1 - Strongly Agree 2 - Agree 3 - Disagree 4 - Strongly Disagree
Wealthy people should be taxed at a higher percentage than poor people. *	1 - Strongly Agree 2 - Agree 3 - Disagree 4 - Strongly Disagree
The government should provide for those who cannot provide for themselves. *	1 - Strongly Agree 2 - Agree 3 - Disagree 4 - Strongly Disagree
Affirmative action policies result in more harm than good. *	1 - Strongly Agree 2 - Agree 3 - Disagree 4 - Strongly Disagree
The freedom of speech, when in conflict with other rights, should be protected above all others. *	1 - Strongly Agree 2 - Agree 3 - Disagree 4 - Strongly Disagree
Medical Conditions/Concerns
Other Comments?

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