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Member Registration Form

Name: Date:
Birthday: Gender:
Ethnicity/Race: Community Organization:
Can we contact you by email?
What is your email address?
What is your telephone number?
How did you find out about YAN?
What do you like the most about YAN?
What contributions do you think you can bring to YAN? (enthusiasm, computer skills, etc…)
Mark all that apply:
I am a student at Grade:
I have access to computers outside this community organization
If so, where? School Home Other:
I have experience with multimedia software
I have experience with email and internet
I know how to draw/paint/sing/…
I have already participated in other community-change initiatives. If so, which one?
I speak other languages
I'm particularly excited about