VTLSP Membership Application (print, fill in, and mail)

Yes! Our school wants to join the Vermont Teen Leadership Safety Program for the year. I understand that the state dues are $100.00 for one year and these dues entitle our school and students grades 9 - 12 to all the membership benefits.

Enclosed is our check (payable to DLC) for _____ $100.00 (VTLSP Dues)

Name of School or Youth Agency _____________________________________________________

Address __________________________ City _____________________ Zip _________

Advisor(s) ____________________________________ Phone # ___________________

E-mail ________________________________________________

For more information call: (802) 763-8969

Mail your registration form and check (payable to DLC) to:

Keri Stasulis

VTLSP/SADD

52 Hillary Lane

Milton, VT 05468