21th Annual African-American Youth Leadership Conference
Theme: Youth Building Respect and Responsibility for Future Rewards
March 2, 2013
The 21th annual African American Youth Leadership Conference (AAYLC) is OPEN TO ALL YOUTH grades 6-12. Since
1992, the AAYLC has been dedicated to educating, empowering, and enlightening, youth to become critical thinkers,
responsible citizens, and embrace the traditions, histories, and cultures of their communities. Today, the AAYLC serves more
than 500 youth annually with students in attendance from Districts 2, 3, 8, 11, 12, 20, 38, 49 and all across Colorado Springs.
This year’s conference, on Saturday, March 2, 2013 at Colorado College in the El Pomar Gym, features student speakers,
community professionals, interactive presentations and small group sessions and is open to ALL students.
Students who register to attend the conference will have the opportunity to participate in an essay contest and receive
information about the Wynn-Marchman Scholarship. A light breakfast will be served as well as lunch. If you would like to
participate, please be sure to:
* Complete and return this registration form with your parent’s signature to your school’s counseling office or directly to the
AAYLC registration committee at African American Youth Leadership Conference: 6660 Delmonico Suite D #450,
Colorado Springs, CO, 80919 by Saturday, February 16, 2013. Completed registration forms will also be accepted by email
by Saturday, February 16, 2013 at: registration@aaylc-co.org Print clearly and complete the form in its entirety.
* Dress appropriately (i.e. NO HATS, BANDANNAS, SAGGING, MID-DRIFFS OR BELLY SHIRTS).
For questions contact: Alex Malone at registration@aaylc-co.org or 719.251.5503 or visit www.aaylc-co.org.
African American Youth Leadership Conference
Saturday, March 2, 2013, 7:30 a.m.-4:30 p.m.
Registration: 7:30 a.m.-8:30 a.m.
The Colorado College (El Pomar Gym)
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Registration Form
Please PRINT all information.
NAME ________________________________
STUDENT (1)
SCHOOL ______________________________
NAME ________________________________
GRADE ____________ AGE ______________
GRADE ____________ AGE ______________
SEX
SEX
F
M
(Please circle)
STUDENT (2)
SCHOOL ______________________________
F
Would you like to receive more information about The Colorado College?
M
(Please circle)
YES__ NO__
This year’s conference features a special workshop designed for parents. This gives parents the opportunity to attend the
AAYLC with their child. Teachers and counselors are also encouraged to attend and participate as well
**I PLAN TO ATTEND PARENT WORKSHOP
YES__________
NO___________
Transportation may be provided by your school district. Check with your school principal or counselor.
Will your child need transportation? Yes ______ No ______
PARENT (S)/GUARDIAN (S) NAME (print)
_______________________________________
PARENT/GUARDIAN SIGNATURE
_______________________________________
DATE _________________________________
TELEPHONE ___________________________
By signing above, I hereby waive and release The AAYLC Committee as well as its servants and volunteers, from any and all liability arising at law or in equity from injury or
death to student resulting from student's participation in the AAYLC. Also, I grant and convey to the AAYLC committee all right, title and interest in my student’s name,
image, voice, statements and/or writings including any and all photographic images and video or audio recordings made by the AAYLC.