• For TECA's use only. Delegate's photo will be taken at orientation.
    Accepted file types: jpg, png, Max. file size: 32 MB.
  • Please upload a scanned copy of the front and back of the delegate's drivers license.
    Drop files here or
    Accepted file types: jpg, png, Max. file size: 32 MB, Max. files: 2.
    • If you are not sure, visit https://www.congress.gov/members/find-your-member .
    • Parents/Guardians

      List the full names of your natural parents, step-parents, and/or legal guardians
    • Emergency Contact Information

      List the names and telephone numbers of two individuals, other than your parents or guardians, who can be contacted in case of an emergency
    • NameRelationshipPhone 
    • Medical Information

    • List drug name and dosage of medications you take regularly.
    • List any dietary needs (vegan, gluten intolerant, etc.)
    • Insurance Data

      Note: This information is required for the Accidental Insurance Coverage. If you do not have health insurance, please select No. Health insurance will be provided for you during the trip.
    • IMPORTANT: You must send the front AND back of card
      Drop files here or
      Accepted file types: jpg, pdf, Max. file size: 32 MB, Max. files: 2.
      • Parental/Guardian Consent

      • Delegate Consent

      • This field is for validation purposes and should be left unchanged.