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Student or Adult*

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Middle School, High School or College age
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(no longer in school)

Club ministry connected to or were connected with ?*

Young Life Alumni
Involved in YL in some way
Capernaum
(Kids with special needs)
Younglives
(Teenmoms)
YL College @ WMU
(College Students)
Wyldlife Otsego
(Middle School)
Young Life Otsego
(High School)
Young Life Kalamazoo Christian
(High School)
Young Life Mattawan
(High School)
Young Life Paw Paw
(High School)
Young Life Portage Central
(High School)
Young Life Portage Northern
(High School)
Young Life Schoolcraft
Young Life Vicksburg
Other

Name*

Date of Birth

Gender

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Female

HS Graduation year

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Phone Number*

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Office

Spouse Name

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Email

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Address*

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