Apply for WECA Youth Leadership Congress! Student Name Student's First Name Student's Last Name Service / Account Information Member Parent(s) Name Member Parent First Name Member Parent Last Name Do you know your Parent's Account # or Member #? Do you know your Parent's Account # or Member #? - Select -NoYes Enter Account # or Member Number … Service Address Address City, State Zip Baldwin, WI 54002 Clear Lake, WI 54005 Deer Park, WI 54007 Emerald, WI 54013 Glenwood City, WI 54013 Hammond, WI 54015 Hudson, WI 54016 New Richmond, WI 54017 River Falls, WI 54022 Roberts, WI 54023 Somerset, WI 54025 Star Prairie, WI 54026 Wilson, WI 54027 Woodville, WI 54028 Houlton, WI 54082 Downing, WI 54734 Knapp, WI 54749 Spring Valley, WI 54767 Parent Main Phone # Parent Main Email Address Student Information Contact Information My Mailing Address is the same as our Service Address Mailing Address Address Address 2 City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle EastArmed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederate States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code My Email Address My Cell/Main Phone Number School Information Grade entering in the fall: 12th (senior) 11th (junior) 10th (sophomore) 9th (freshman) High School: High School: - Select -Baldwin-Woodville High SchoolClear Lake High SchoolGlenwood City High SchoolHill-Murray SchoolHomeschoolHudson High SchoolNew Richmond High SchoolRiver Falls High SchoolSomerset High SchoolSpring Valley High SchoolSt. Croix Central HIgh SchoolSt. Croix Lutheran AcademyOther… Enter High School name… Why do you want to attend WECA Youth Leadership Congress? Additional Comments or Questions: Submit
