Michigan Youth in Government: Online Registration v1.0
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What program would you like to register for?
Select a Program
Early March High School
Late March High School
Middle School
Which delegation would you like to register with?
Select a Delegation
What role will you be playing in this program?
Select Role
Student
Advisor
Please provide some information about yourself:
Full Name:
Cell Phone:
Home Phone:
Work Phone:
Fax Phone:
E-mail Address:
Mailing Address:
,
District
Select district...
Central
Southeast
Southwest
Upper Peninsula
Date of Birth:
/
/
Sex:
Male
Female
Grade:
Select Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
College
Adult
Ethnicity (optional):
Select Ethnicity
Black/African-American
White/Caucasian
Mideastern
Asian/ Pacific-American
Latino/Hispanic
Native American
T-Shirt Size:
Shirt Size
Youth M
Youth L
Adult S
Adult M
Adult L
Adult XL
Adult XXL
Vegetarian?
No, I am not a Vegetarian
Yes, I am a Vegetarian
Food Allergies:
This will be my...
How many years have you been participating?
1st Conference Year
2nd Conference Year
3rd Conference Year
4th Conference Year
5th Conference Year
6th Conference Year
7th Conference Year
7+ Conference Years
Room Preference:
Select a Preference
Single Bed
Double Bed
Please provide some program details:
First Choice:
I want to be a...
House Advisor
Senate Advisor
Conference Affairs Advisor
Committee Advisor
Chaplain Advisor
Contemporary Issues Forum Advisor
Second Choice:
I want to be a...
House Advisor
Senate Advisor
Conference Affairs Advisor
Committee Advisor
Chaplain Advisor
Contemporary Issues Forum Advisor
Please provide an Emergency Contact:
Contact Name:
Contact Phone:
Please provide some information about yourself:
Full Name:
Cell Phone:
Home Phone:
E-mail Address:
Mailing Address:
,
Date of Birth:
/
/
Sex:
Male
Female
Grade:
Select Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
College
Adult
Ethnicity (optional):
Select Ethnicity
Black/African-American
White/Caucasian
Mideastern
Asian/ Pacific-American
Latino/Hispanic
Native American
T-Shirt Size:
Shirt Size
Youth M
Youth L
Adult S
Adult M
Adult L
Adult XL
Adult XXL
Vegetarian?
No, I am not a Vegetarian
Yes, I am a Vegetarian
Food Allergies:
This will be my...
How many years have you been participating?
1st Conference Year
2nd Conference Year
3rd Conference Year
4th Conference Year
5th Conference Year
6th Conference Year
7th Conference Year
7+ Conference Years
Please provide some program details:
First Choice:
I want to be in the...
Senate
House
Contemporary Issues Forum
Second Choice:
I want to be in the...
Senate
House
Contemporary Issues Forum
Leadership Position:
I'm not applying for leadership position
Lt. Governor
Speaker of the House
Chaplain
Committee Chair
Secretary of the Senate
Senate Reading Clerk
House Clerk
House Reading Clerk
Committee Clerk
Please provide some information about your parents:
1st Parent Name:
- Work Phone:
2nd Parent Name:
- Work Phone:
Please provide an Emergency Contact:
Contact Name:
Contact Phone:
Please provide some information about yourself:
Full Name:
Cell Phone:
Home Phone:
Work Phone:
Fax Phone:
E-mail Address:
Mailing Address:
,
District
Select district...
Central
Southeast
Southwest
Upper Peninsula
Date of Birth:
/
/
Sex:
Male
Female
Ethnicity (optional):
Select Ethnicity
Black/African-American
White/Caucasian
Mideastern
Asian/ Pacific-American
Latino/Hispanic
Native American
Grade:
Select Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
College
Adult
T-Shirt Size:
Shirt Size
Youth M
Youth L
Adult S
Adult M
Adult L
Adult XL
Adult XXL
Vegetarian?
No, I am not a Vegetarian
Yes, I am a Vegetarian
Food Allergies:
This will be my...
How many years have you been participating?
1st Conference Year
2nd Conference Year
3rd Conference Year
4th Conference Year
5th Conference Year
6th Conference Year
7th Conference Year
7+ Conference Years
Room Preference:
Select a Preference
Single Bed
Double Bed
Please provide some program details:
First Choice:
I want to be a...
Red/Green House Advisor
Red/Green Senate Advisor
Blue/White Legislature Advisor
Chaplain Advisor
Committee Advisor
Lobbyist Advisor
Page Advisor
Electronic Press Advisor
Written Press Advisor
MJP Advisor
Governor's Cabinet Advisor
Transportation
Conference Affairs Advisor
National Issues Forum Advisor
Second Choice:
I want to be a...
Red/Green House Advisor
Red/Green Senate Advisor
Blue/White Legislature Advisor
Chaplain Advisor
Committee Advisor
Lobbyist Advisor
Page Advisor
Electronic Press Advisor
Written Press Advisor
MJP Advisor
Governor's Cabinet Advisor
Transportation
Conference Affairs Advisor
National Issues Forum Advisor
Third Choice:
I want to be a...
Red/Green House Advisor
Red/Green Senate Advisor
Blue/White Legislature Advisor
Chaplain Advisor
Committee Advisor
Lobbyist Advisor
Page Advisor
Electronic Press Advisor
Written Press Advisor
MJP Advisor
Governor's Cabinet Advisor
Transportation
Conference Affairs Advisor
National Issues Forum Advisor
Please provide an Emergency Contact:
Contact Name:
Contact Phone:
Please provide some information about yourself:
Full Name:
Cell Phone:
Home Phone:
E-mail Address:
Mailing Address:
,
District
Select district...
Central
Southeast
Southwest
Upper Peninsula
Date of Birth:
/
/
Sex:
Male
Female
Ethnicity (optional):
Select Ethnicity
Black/African-American
White/Caucasian
Mideastern
Asian/ Pacific-American
Latino/Hispanic
Native American
Grade:
Select Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
College
Adult
T-Shirt Size:
Shirt Size
Youth M
Youth L
Adult S
Adult M
Adult L
Adult XL
Adult XXL
Vegetarian?
No, I am not a Vegetarian
Yes, I am a Vegetarian
Food Allergies:
This will be my...
How many years have you been participating?
1st Conference Year
2nd Conference Year
3rd Conference Year
4th Conference Year
5th Conference Year
6th Conference Year
7th Conference Year
7+ Conference Years
Please provide some program details:
First Choice:
I want to be in the...
House
Senate
Lobbyist Corps
Written Press Corps
Electronic Press Corps
Page Corps
Governor's Cabinet
Model Judiciary Program - Mock Trial
Model Judiciary Program - Appellate
National Issues Forum
Second Choice:
I want to be in the...
House
Senate
Lobbyist Corps
Written Press Corps
Electronic Press Corps
Page Corps
Governor's Cabinet
Model Judiciary Program - Mock Trial
Model Judiciary Program - Appellate
National Issues Forum
Third Choice:
I want to be in the...
House
Senate
Lobbyist Corps
Written Press Corps
Electronic Press Corps
Page Corps
Governor's Cabinet
Model Judiciary Program - Mock Trial
Model Judiciary Program - Appellate
National Issues Forum
Run for Office:
I am not running for office
Governor Candidate
Conference Life Committee Representative
Lt. Governor
Speaker of the House
Chaplain
Committee Chair
Secretary of the Senate
Senate Reading Clerk
House Clerk
House Reading Clerk
Committee Clerk
Please provide some information about your parents:
1st Parent Name:
- Work Phone:
2nd Parent Name:
- Work Phone:
Please provide an Emergency Contact:
Contact Name:
Contact Phone:
Two Party Dynamics Survey:
Answer each question:
1.
Strongly Agree
2.
Agree
3.
Neutral
4.
Disagree
5.
Strongly Disagree
1
2
3
4
5
I believe change is good even if it’s for the sake of change.
The Federal government, not the State government, should hold the most power.
I believe taxes should provide services to American people.
I believe in National standards for educational purposes.
I am in favor of government resources for public welfare.
I am in support of a national minimum wage.
Please provide some information about yourself:
Full Name:
Cell Phone:
Home Phone:
Work Phone:
Fax Phone:
E-mail Address:
Mailing Address:
,
District
Select district...
Central
Southeast
Southwest
Upper Peninsula
Date of Birth:
/
/
Sex:
Male
Female
Ethnicity (optional):
Select Ethnicity
Black/African-American
White/Caucasian
Mideastern
Asian/ Pacific-American
Latino/Hispanic
Native American
Grade:
Select Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
College
Adult
T-Shirt Size:
Shirt Size
Youth M
Youth L
Adult S
Adult M
Adult L
Adult XL
Adult XXL
Vegetarian?
No, I am not a Vegetarian
Yes, I am a Vegetarian
Food Allergies:
This will be my...
How many years have you been participating?
1st Conference Year
2nd Conference Year
3rd Conference Year
4th Conference Year
5th Conference Year
6th Conference Year
7th Conference Year
7+ Conference Years
Room Preference:
Select a Preference
Single Bed
Double Bed
Please provide some program details:
First Choice:
I want to be a...
Red/Green House Advisor
Red/Green Senate Advisor
Blue/White Legislature Advisor
Chaplain Advisor
Committee Advisor
Lobbyist Advisor
Page Advisor
Electronic Press Advisor
Written Press Advisor
MJP Advisor
Governor's Cabinet Advisor
Transportation
Conference Affairs Advisor
National Issues Forum Advisor
Second Choice:
I want to be a...
Red/Green House Advisor
Red/Green Senate Advisor
Blue/White Legislature Advisor
Chaplain Advisor
Committee Advisor
Lobbyist Advisor
Page Advisor
Electronic Press Advisor
Written Press Advisor
MJP Advisor
Governor's Cabinet Advisor
Transportation
Conference Affairs Advisor
National Issues Forum Advisor
Third Choice:
I want to be a...
Red/Green House Advisor
Red/Green Senate Advisor
Blue/White Legislature Advisor
Chaplain Advisor
Committee Advisor
Lobbyist Advisor
Page Advisor
Electronic Press Advisor
Written Press Advisor
MJP Advisor
Governor's Cabinet Advisor
Transportation
Conference Affairs Advisor
National Issues Forum Advisor
Please provide an Emergency Contact:
Contact Name:
Contact Phone:
Please provide some information about yourself:
Full Name:
Cell Phone:
Home Phone:
E-mail Address:
Mailing Address:
,
District
Select district...
Central
Southeast
Southwest
Upper Peninsula
Date of Birth:
/
/
Sex:
Male
Female
Ethnicity (optional):
Select Ethnicity
Black/African-American
White/Caucasian
Mideastern
Asian/ Pacific-American
Latino/Hispanic
Native American
Grade:
Select Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
College
Adult
T-Shirt Size:
Shirt Size
Youth M
Youth L
Adult S
Adult M
Adult L
Adult XL
Adult XXL
Vegetarian?
No, I am not a Vegetarian
Yes, I am a Vegetarian
Food Allergies:
This will be my...
How many years have you been participating?
1st Conference Year
2nd Conference Year
3rd Conference Year
4th Conference Year
5th Conference Year
6th Conference Year
7th Conference Year
7+ Conference Years
Please provide some program details:
First Choice:
I want to be in the...
House
Senate
Lobbyist Corps
Written Press Corps
Electronic Press Corps
Page Corps
Governor's Cabinet
Model Judiciary Program - Mock Trial
Model Judiciary Program - Appellate
National Issues Forum
Second Choice:
I want to be in the...
House
Senate
Lobbyist Corps
Written Press Corps
Electronic Press Corps
Page Corps
Governor's Cabinet
Model Judiciary Program - Mock Trial
Model Judiciary Program - Appellate
National Issues Forum
Third Choice:
I want to be in the...
House
Senate
Lobbyist Corps
Written Press Corps
Electronic Press Corps
Page Corps
Governor's Cabinet
Model Judiciary Program - Mock Trial
Model Judiciary Program - Appellate
National Issues Forum
Leadership Position:
I'm not applying for leadership position
Governor Candidate
Conference Life Committee Representative
Lt. Governor
Speaker of the House
Chaplain
Committee Chair
Secretary of the Senate
Senate Reading Clerk
House Clerk
House Reading Clerk
Committee Clerk
Please provide some information about your parents:
1st Parent Name:
- Work Phone:
2nd Parent Name:
- Work Phone:
Please provide an Emergency Contact:
Contact Name:
Contact Phone:
Two Party Dynamics Survey:
Answer each question:
1.
Strongly Agree
2.
Agree
3.
Neutral
4.
Disagree
5.
Strongly Disagree
1
2
3
4
5
I believe change is good even if it’s for the sake of change.
The Federal government, not the State government, should hold the most power.
I believe taxes should provide services to American people.
I believe in National standards for educational purposes.
I am in favor of government resources for public welfare.
I am in support of a national minimum wage.