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Membership Application
Apply to join Upstream.
$75 per year · January through December. Applications are reviewed by an administrator before any portal account is created.
Student information (ages 13–18)
First name
*
Last name
*
Student email
*
Used for the student's own portal login
Student phone
Date of birth
*
Grade
School
City
Preferred program location
*
Heidelberg
Vicksburg
Parent / guardian information
Full name
*
Relationship to student
*
Email
*
Must differ from the student's email
Phone
*
Anything else we should know?
Parent / guardian consent
I am the parent or legal guardian of this student. I consent to their application for Upstream membership and understand membership is $75 per year and is confirmed only after administrator approval and verified payment.
Guardian signature (type full name)
*
Submit application
