Teen Peace Jam Registration

Plowshare Peace Center Teen

Peace Jam Registration Form        

Name _______________________________________________________________________

Email:  ______________________________________________________________________

Cell phone or other phone:  ______________________________________________________

Address  _____________________________________________________________________

(For teens) School:  ____________________________________________________________

(For teens) Grade: _____________________________________________________________

(For teens) Age: _______________________________________________________________

For teens:

If registering with a group, name of group:


Group contact and phone


Parent or adult sponsor name:  _________________________________________

Parent or adult sponsor email __________________________________________

Parent or adult sponsor mailing address__________________________________

PLEASE NOTE: We plan to include you on the Plowshare mail & email list if you have attended the Teen Peace Jam.  You will receive information about the next Teen Peace Jam and other Plowshare projects. (We send out only occasional emails and just a quarterly newsletter!)  If you don’t wish to receive emails and newsletters, please check off here: No, I’d rather not receive Plowshare emails and newsletters  ______