Please provide the following contact information:

First Name
Last Name
Middle Initial
Address
City
State	IL MO
Zip
Date of Birth D/M/Y
Current Class	Freshman Sophomore Junior Senior
Home Phone
E-mail

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Areas of interest. Please check all that apply
Lasallian Youth Meetings (Tuesday AM)
Freshman Prayer Group (Tuesday AM)
Thursday Morning Prayer Group
Mission to Mexico
Tutoring at De La Salle at St. Matthew
Lasallian Youth Retreat
De La Salle Blackfeet (July 1-11)
Lasallian Youth Summer Gathering (June 25-July 1)
TASK Camp (July 25-29)

What would you like to see happen with Lasallian Youth?