...advocating for evidence based policies and practices to prevent and reduce alcohol-related harms

Virtual Youth Leadership Retreat Application Form

We have no doubt the virtual Youth Leadership Retreat 2022 will be an exciting time as we work to teach new, young advocates how to engage in the underage drinking issue to change the environment of their communities.

Registration Deadline is August 12th!

Only 40 students will be selected to participate, so don't wait!

Questions? Call Project Extra Mile at (402) 963-9047 or email us at info@projectextramile.org.

First Name*

Last Name*

Address 1*

Address 2

City*

State*

Zip*

Student Email Address*

Home Phone Number*

Cell Phone Number*

T-Shirt Size*

High School Attending*

Grade in school for 2022-2023 school year*

Gender*

Parent/Guardian Name(s)*

Best number to contact parent/guardian*

Parent/Guardian Email Address*

Dietary Restrictions*