Membership Application & Life Skills with AEYL

Lead Your Life.

Build Your Future.

MEMBERSHIP APPLICATION: Pathway to Success for Teens (12-18).

We exist to help elite teens unlock their leadership potential, prepare for real-world success, and make a lasting impact—on their lives, their families, and their communities.

Where young people develop the tools to lead with purpose, grow in confidence, and navigate life successfully. Whether you're a teen finding your voice or stepping into new responsibilities of post-high school pathways, this weekly program helps you build real-world skills, form lasting connections, and stay on track for success.

Potential Member Information

First Name *

Last Name *

Parent/Guardian Full Name *

Email *

Phone *

Address

Street Address *

City *

State *

Country *

Postal code *

Date of Birth *

School Attended? *

GPA *

Gender? *

Ethnicity? *

Household Income? *

Family Household Size? *

Membership | Program Interest? *

Parent/Guardian Consent & Liability Waiver: I, the undersigned, am a parent/legal guardian and I hereby give permission for my child to attend and participate in the Youth in Government Day event. I acknowledge and agree that my child’s participation is voluntary. I release and hold harmless all directors, facilitators, organizers, and staff associated with the planning, implementation, and execution of this event from any and all liability, claims, or damages arising from my child’s participation. I also consent to the use of my contact information provided in the registration form for non-marketing purposes, including messaging, promotional special offers, updates, and follow-ups related to this event. Furthermore, I give permission for photography, videography, and verbal testimony of my child during the event to be used for promotional, educational, or informational purposes.

Clear