SPONSORED BY:

Flint Area Right to Life & Black Americans for Life
_____________________________________________________________________________

Application Form (Please Print)

NAME: ____________________________________________________________________

ADDRESS: ________________________________________________________________

CITY/STATE/ZIP: ____________________________________________________________

PHONE:_______________________________ BIRTH DATE:  ________________________

EMAIL:_______________________________ GRADE (2022-2023):  ___________________

NAME OF SCHOOL: _________________________________________________________

STUDENT SIGNATURE: ______________________________________________________

PARENT/GUARDIAN SIGNATURE:______________________________________________
(if Minor)

Topic of Speech (Please Check One):

__Abortion      __Black Genocide     __RU486 Pills

__Abortion & Sex Trafficking      ___Planned Parenthood

Contest Date: April 29, 2023 @ 10 AM 

Please return this form by April 24, 2023 to:

FLINT AREA RIGHT TO LIFE
G-4482 N. Genesee Road, Unit C, Flint, MI 48506
Phone: (810) 250-0218; Email: FlintRTL@att.net
VISIT US ON THE WEB: www.FlintRTL.com

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