Skip to main content

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.

 

Contact:
eXtreme Youth Programs 
505 Dixie Drive
El Dorado, AR 71730
870-864-5081 ext: 2031
Debbie Watts: dwatts@sharefoundation.com

First Name
Middle Initial/Name
Last Name
/
/
Country
Address Line 1
City
State
Postal Code
First Name
Last Name
Shirt Size
Grade
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

SHARE Agencies