Contact Information

Address:

Maine YMCA Youth in Government

31 Town Hall Lane

Winthrop, ME 04364

Director: Lonney Stevens

Phone: 207 - 377 - 9686

* Required Fields

* First Name:

* Last Name:

* Grade:

* School / Club / YMCA:

* Gender:

Male Female

* Age:

* Email:

Training Session:

Housing Information:

I will be staying at home

My delegation has Arranged to stay in a hotel

I need to be assigned a Host Family

* Parent's Name:

* Home Phone:

* Address Line 1:

* Address Line 2:

* City / Town:

* Zip:

Insurance Carrier:

Insurance Policy #

Allergies:

Medications:

Medical Conditions:

Return to Top