EmailThis field is for validation purposes and should be left unchanged.Delegate Application 2025 East Texas Rural Electric Youth Seminar East Texas Baptist University, Marshall, Texas June 8 through June 12, 2026 About ETREYS East Texas Rural Electric Youth Seminar (“ETREYS”), is a leadership and educational seminar for high school youth, organized and sponsored by a group of non-profit electric cooperatives (“Cooperatives”) utilizing Cooperative employees, volunteers, youth leaders, chaperones, speakers, and other professionals (collectively herein, “ETREYS Staff”). High school youth are selected and invited by each of the organizing Cooperatives to participate in ETREYS at no cost to the participant or “Delegate”. ETREYS INC., the Cooperatives, and all ETREYS Staff are collectively referred to in this “Agreement” as the “ETREYS Parties”. To qualify for consideration as a Delegate, please provide the following information and sign the “Agreement for Consideration” found at the end.Applicant InformationName(Required) First Last Address(Required) Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Contact Phone(Required)Date of Birth(Required) MM DD YYYY Email(Required) Family/Guardian InformationMother/Guardian Name(Required) First Last Phone Number(Required)Secondary Phone/Work NumberEmail(Required) Father/Guardian Name(Required) First Last Phone Number(Required)Secondary Phone/Work NumberEmail(Required) Name of Your Electric Provider(Required)School Information Applicant’s High School:(Required)Graduation Year:(Required)Class Ranking Next School Year (Jr., Sr., etc.):(Required)Grade Average (GPA):(Required)School/Organizations Extracurricular ActivitiesList high school activities, including leadership positions, organizations, class offices, academic awards, etc.:(Required)List civic and other activities:(Required)List goals and aspirations after High School:(Required)Why would you like to attend ETREYS?(Required)Letters of RecommendationProvide 2 letters of recommendation from a professional, non-family member, such as a teacher, principal, counselor, or pastor.(Required) Drop files here or Select files Max. file size: 50 MB. Applicant PhotoPlease attach a recent, clear head shot photo for use in the student directory and for ETREYS promotions. This should be similar to photos taken for yearbook. No photocopies please. Photo must be of high quality that can be reproduced in a magazine. Your photo may also be submitted digitally by uploading the it via this form. Please make sure your name is the name of the photo file.File(Required) Drop files here or Select files Max. file size: 50 MB. Delegate Adult T-Shirt SizePlease select your adult t-shirt size:(Required)SmallMediumLargeXL2XL3XL4XLUse of Likeness Grant & ReleaseIn consideration for the opportunity to participate in ETREYS, the undersigned “Applicant” and the undersigned parent/legal guardian(s) (herein, “Guardian”) for himself or herself and also on behalf of Applicant hereby consent to the ETREYS Parties capturing images or sound recordings in any form of Applicant in connection with Applicant’s possible participation in ETREYS. Further, Applicant and Guardian hereby assign and grant to the ETREYS Parties, as well as their authorized representatives, the right and permission to use any images or sound recordings of Applicant captured in any form by the ETREYS Parties or provided to the ETREYS Parties by Applicant or Guardian (collectively, “Likeness”). Applicant and Guardian also releases the ETREYS Parties, the affiliates of the Cooperatives and the respective directors, officers, representatives, members, agents, and employees of the proceeding parties from any and all liability that may arise from the use or publication of Applicant’s Likeness in any form known or unknown. Applicant and Guardian further authorize the reproduction, sale, copyright, exhibit, broadcast, electronic storage, and/or distribution of said Likeness without limitation at the discretion of the ETREYS Parties, and specifically waive any right to any compensation they may have for any of the foregoing.Agreement for ConsiderationApplicant Consent(Required)In consideration for the opportunity to participate in ETREYS, Applicant and Guardian acknowledge and agree by their signatures below as follows: They have carefully read the “Use of Likeness Grant and Release” above, understand its contents, and agree to its contents. They acknowledge that they have reviewed all the information provided in this Application and certify that such information is true and correct They consent to the ETREYS Parties’ review of the information contained in this Application and authorize the ETREYS Parties to confirm the information by any means determined by the ETREYS Parties. They understand that if any information in this Application is found to be inaccurate or misleading, it may result in Applicant’s dismissal from participation in ETREYS if Applicant is selected to be a Delegate. In no way limiting the rights already granted to the ETREYS Parties in the “Use of Likeness Grant and Release” provision above, they consent to Applicant’s name and Likeness being published or used in connection with Applicant’s selection as an ETREYS Delegate, Applicant’s selections for an ETREY’S scholarship, or the promotion of ETREYS. They understand that any Applications that are incomplete, completed inconsistently with the Application’s instructions, or submitted after the Application deadline of March 10th may not be considered. I hereby verify the information to be true and complete and agree to the terms and conditions. I understand that by typing my full name and pressing the Submit button, this form submission will be stamped with today’s date and authorized by me as if I had signed my signature.Applicant Electronic Signature (Full Name)(Required)Date(Required) MM DD YYYY Guardian Electronic Signature (Full Name)(Required)Date(Required) MM DD YYYY Additional Guardian Electronic Signature if applicable (Full Name)Date MM DD YYYY
