Leadership Training Conference Washington D C
March 24, 2008 Monday 6:00 AM - 10:30 PM
Let's Learn More about America
Opening Young Minds and Expanding Horizons
Building Capacity, Fostering Opportunity, Investing in the Future
Enhancing Good and Productive Citizenship
Meet, Visit, Greet, Brief
Senior Officials, Heritage Foundation (confirmed)
US Capitol (confirmed)
Senior Officials, US Department of Justice (confirmed) White House (pending security clearance and reconfirmation)
US Library of Congress (confirmed)
Senior Officials, US Mint (confirmed)
(subject to amend, change, and modification)
RSVP by March 7, 2008
Email _______________________________ Tel ________________________
Date of Birth __________________________________________________________________
Place of Birth _________________________________________________________________
Social Security Number (for security clearance purpose only)______________________________
Father's/Mother's/Guardian's Name _________________________________________________
Mailing address ________________________________________________________________
Tel ______________________ Fax ________________ Email __________________________
Name of school ______________________________________________________
Principal's name ______________________________________________________
Tel: _____________________ Fax: ________________ Email _________________
Confirmed student participants will be invited to an orientation workshop+ which will include a lecture on
+March 16, 2008 2:00 PM - 5:00 PM
How to Build Brain Power?
How to Enhance Academic Performance?
Preparing for College/University/Graduate School/Professional School (i.e., PhD, JD, MBA, MD)
Preparing for Post-College/University Career Development
Qualified student participants may be invited to compete for **ICAS Youth Excellence Fellowship Awards Contest Invitational 2008.
**ICAS Youth Fellowship Award
ICAS Youth Excellence Fellowship Awards Invitational 2005 Winners
Youth Excellence Award Winners
Release of Liability
Date this form executed _______________________________
Applicant's Name ________________________________ DOB _________________________
Age __________________ Grade ___________________ Signature ______________________
Parent/s, Guardian/s Name/ _________________________________________________________
Mailing Address _________________________________________________________________
Name of School you attend _________________________________________________________
Principal's Name _____________________________
Tel ________________________ Fax _________________ Email ______________________
Emergency Contact Person __________________________________________________________
Relationship _________________ Tel __________________ Email _________________________
Any Concerns (i.e., medical, et al) of which we should be aware. (Please use a separate page if needed)
Health Insurance Inforamtion: Policy Name _____________________________________________
Policy Holder _____________________________________________
Policy Number ____________________________________________
How did you hear about the ICAS Youth Excellence Program (ICASYEP)?
Did you participate in the ICASYEP during the past year?
Release of Liability
I verify that I am physically fit and that my physical condition has been verified by a licensed medical doctor. I also hereby consent to permit emergency treatment in the event of injury or illness.
Signature of parent(s)/guardin _______________________________
NB: A parent/guardian must fill in this form.
ICAS reserves all rights including the right to dismiss any participant and, in that case, no refunds shall be made. Any cancellation requiring a refund must be made in writing with two weeks advance notice. Otherwise, there shall be no refunds. Further details will be provided upon completion of registration.
ICAS Liberty Foundation seeks to promote the cause of humanity, peace, prosperity and security through cultural, educational and research activities.
All rights reserved. February 14, 2008