Young America's Foundation

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YAF's College Conference at the Reagan Ranch

November 9 to 10, 2012

*Student Email Address    
Would you like to receive activism ideas and opportunities following the conference?
*Student First Name

*Student Last Name

*Sex (Male or Female)

*Mailing Address







*Cell Phone 


*Home Mailing Address 


*Home City 


*Home State 


*Home Zip 


Home Phone 


If you use twitter, what name do you tweet under?

*Parent Names 


*Emergency Contact Name & Relation 


*Emergency Contact Phone

*Date of Birth (mm/dd/yyyy)
   /    /   

*Name of School 


*Year In School             (Freshman,Sophomore, Junior, Senior)

*Anticipated Graduation Date (ex. Spring 2013)    

Secondary Email

Special Food Needs/Allergies?

Are you a member of a conservative group on campus? What is the name of the group? 


In a few sentences, please tell us what you have done to advance conservative ideas on your campus and what do you hope to gain by attending this conference?  

*Where did you find out about this  conference?
*How did you first hear about Young America's Foundation? Who introduced you to the Foundation? 

*Are any of your family members involved with Young America's Foundation?

If yes, who?

Choose One:

You will be placed in a room assigned by Young America's Foundation with one roommate or you can arrange your own hotel accommodations (at your cost) and do not need Young America's Foundation to include you on the rooming list.

Who is your requested roommate?
Payment Information -   Early Bird $20 (Deadline: October 17th) After October 17th the tuition fee is $35.00. *You will not be charged unless you are chosen to attend, but the information is required here.* 

Credit Card Number   
   /   /   /   
Expiration Date (mm/yyyy)
Name on Card
Billing Address     
Billing City
Billing State
Billing Zip
Promo Code    



1) I understand that I must attend all sessions of YAF's College Conference at the Reagan Ranch to be held November 9 to 10. If I do not attend, I will be charged the full cost of the conference and events, including the hotel, food, and associated charges, which are $250.00 per attendee, except in the case of an emergency. I must notify Young America's Foundation
of my inability to attend before October 29, 2012 at 5:00 PM EST to avoid these

 2) I understand that the conference fee indicated above is non-refundable, unless I notify
Young America's Foundation by 5:00 p.m. EST on Monday, October 29, 2012.

 3) I understand I will be assigned a roommate for the conference, unless I indicate on the
application form that I am making my own hotel arrangements. I may request preferred
roommates of the same sex, but there is a chance I may not be able to room with them. If
I want to guarantee a room to myself or ensure specific roommates, I will be completely responsible for my own hotel accommodations and book the hotel room myself and notify Young America's Foundation of my plan immediately to avoid the charges listed in item 1.

 4) I agree to all rules listed here and promise to abide by all rules and instructions of Young
America's Foundation and the hotel which I will be placed during the conference. If I
am signing others up on their behalf, I understand I am responsible for making sure they
understand and abide by these rules, including any costs associated with failure to attend,
as listed in item 1.

 5) Young America's Foundation uses real photos, videos, and quotes from our students for
promotional purposes and to advance our mission. By attending this program, I consent
to the use of my photo, written evaluation statements, and video in any Young America's
Foundation materials.

6) I understand that I will only be charged if I have been confirmed to attend. 

  to Young America's Foundation's terms and conditions above concerning this conference. 


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