Name |
|||||||
Address |
|||||||
City, State Zip |
|||||||
Phone |
|||||||
School |
|||||||
Grade |
|||||||
Workshop Choices: You will attend three hands-on workshops sessions. Please list the session number of your first six (6) choices in the boxes below in the order of your preference. Click here to see the list of workshops. |
|||||||
|
|||||||
To request the same workshop session with a friend, write her name here and send your forms together in the same envelope. We cannot guarantee placement in the same session. |
Friend's Name |
||||||
Special Needs |
|||||||
please let us know special needs by Feb. 27 |
|||||||
Parent/Guardian Permission: (This MUST be completed and signed.)I give permission for my daughter to attend the Expanding Your Horizons Conference on March 8, 2008 in Springfield, Illinois. I give permission for an adult conference organizer to seek emergency medical treatment for her if I cannot be contacted. |
|||||||
Signature |
|||||||
Phone (during conference) |
|||||||
Emergency contact name and phone during conference |
|||||||
|
|||||||
Name |
||
Address |
||
City, State Zip |
||
Phone |
||
Parent |
||
Educator |
||
Other |
||
Fees and Registration: There is a fee for each student or adult who attends. Confirmation will be mailed to you with directions and a map.
|
|||||||||||
LOCATION: The conference will be held at the Public Affairs Center on the campus of the University of Illinois at Springfield. Confirmation of your registration will be mailed to you along with a map and directions to the University of Illinois at Springfield. |
|||||||||||