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Register with MYP
Name
 First


Middle


Last
Birth Date
MM DD YYYY
1.
 What are your plans after graduating from high school?
2.
 If you are attending college/university, give the name:
3.
 Please give us your address for September onward:
4.
 School Street Address
  City


State


Zip
  Telephone


Email
5.
 Permanent Street Address  
  City


State


Zip
  Telephone
6.

If you are relocating to a new community for work/study/military assignment, would you like to be matched with a campus ministry or congregation?
Yes No

In what ways could the office for Young Adult & Higher Education Ministries be helpful to you?

If you know of any other persons whom we should contact, please list them here:

Thanks for taking part! We will be sure to contact you with information about upcoming provincial and national events.

You can contact us at:
Office for Young Adult & Higher Education Ministries
The Rev. G. Douglas Fenton, Staff Officer
Episcopal Church Center
815 Second Avenue
New York, NY 10017
email: dfenton@episcopalchurch.org