All In Summit Junior Participant Form Legal Name (as reflected on your I.D.)(Required) Date of birth?(Required) Gender?(Required) How will you be travelling to the event?(Required) Air Auto *If Civitan is not covering the cost of your flight you are responsible for covering the cost of your own travel accommodations, however Civitan can arrange to have your accommodations booked with our travel agent, should you be travelling with another participant. Please note that booking with our travel agent will incur a ticketing fee of $45.If Civitan is not covering the cost of your flight, would you like Civitan to book your travel using out travel agent, as mentioned above? Yes No If air, what is your first choice of airport? If air, what is your second choice of airport? Health Insurance Provider(Required) Health Insurance Policy #(Required) Health Insurance Group Number(Required) Address(Required) City, St(Required) Zipcode(Required) List up to 3 roommate preferences. You will be in a room of 4 (two twin bunkbeds). We will try our best to accommodate your roommate preference. Do you prefer a hot or cold room?(Required) I want to feel like I’m at the beach I want to be a popsicle This is to help with roommate matching.Are you messy or a neat freak?(Required) A bit messy I watch fridge restocks on Tick Tok This is to help with roommate matching.Do you shower/get ready in the mornings or at night?(Required) Morning Evening This is to help with roommate matching.T-Shirt Size(Required) Small Medium Large Extra Large Extra-Extra Large Please explain any medical information of which we should be made aware. List all allergies to medication, food, animals, etc.(Required)List any dietary restrictions (Example: vegetarian, vegan, gluten-free, etc.)(Required)Please include any additional information you need Civitan International to know.(Required)Emergency Contact Name(Required) Emergency Contact Relationship(Required) Example: parent, guardian, etc.Emergency Contact Phone Number(Required) Emergency Contact Email(Required)
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