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eXtreme Youth Programs

eXtreme Youth Programs Application 20-21

eXtreme Youth Programs Application 20-21

Membership Application 2020-2021 
Dues & T-shirt: $20.00 Until November 17, 2020
$25.00 after November 18, 2020
CASH or online payments accepted.


eXtreme Youth Programs 
505 Dixie Drive
El Dorado, AR 71730
870-864-5081 ext: 2031
Debbie Watts:

First Name
Middle Initial/Name
Last Name
Address Line 1
Postal Code
First Name
Last Name
Shirt Size
I pledge to live a life without drugs, alcohol, tobacco, or vaping regardless of peer pressure. I would like to go to school and learn without being interrupted by the problems of drugs and alcohol.
I pledge to learn about the harms of drugs and tell my peers the truth about the harmful effects.
I pledge to educate others.
I pledge to stay in school and learn.
Dues & T-shirt: $20.00
Credit Card Information
Visa MasterCard American Express Discover
Your total payment will be
Your credit balance will cover
Your credit card will be charged
Your bank account will be charged

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