Expanding Your Horizons

Saturday, February 21, 2015

Registration Form

1. Complete a registration form for EACH participant (parent + daughter = 2 forms).

2. Submit only original signed forms. Include a check for $6 payable to West Harris County AAUW/EYH for each person OR
visit www.eyhhouston.org to pay by credit card.
3. Registration forms may be completed online, printed, and mailed. To complete form online, go to www.eyhhouston.org,
click Registration and follow instructions.
4. Registration is not complete until we receive the signed permission slip and payment.
5. Group registrations will be acknowledged by email when a group leaders email address is provided as requested below.
6. No registrations will be taken at the door.

Space is limited to 450 students, so register early!

Mailing Address: West Harris County AAUW/EYH, PO Box 821125, Houston, TX 77282-1125

Web Address: www.eyhhouston.org

Tell us about YOU (check ONE): Grade 6

Grade 7
Grade 8
Parent
Lead Teacher
Teacher
Please check here if a parent (mom or dad) will also attend and has a separate registration form with payment of $6

Other

Please print clearly in blue or black ink:

Last Name

First Name

School District

School

Group Leader (if applicable)

Group Leaders Email

Home Phone

Responsible Adults Email

Ethnicity (check one): African American

Asian

Caucasian

Is English the language your family usually speaks at home? Yes

Hispanic
No

Native American

Other

Is this your first EYH conference? Yes

No

Student Session Categories: Students will attend 4 sessions with a woman professional who works in one of the categories listed inside this
form (medicine, engineering, etc.). Students, please circle a different letter for the category you want in each session. Every attempt is made to
assign you to the categories you select. Adults, please do the same. If you do not make any choices, our computer will make them for you.
Example: 1st Choice: A B C D E

2nd Choice: A B C D E

Student Registration Morning, Categories AE: 1st Choice: A B C D E

2nd Choice: A B C D E

3rd Choice: A B C D E

Afternoon, Categories JN: 1st Choice: J K L M N

2nd Choice: J K L M N

3rd Choice: J K L M N

Adult Registration

Morning Sessions (AADD):

Afternoon Sessions (KKOO)

1st Choice______ 2nd Choice______ 3rd Choice _____

1st Choice______ 2nd Choice______ 3rd Choice _____

(We have found that girls are intimidated when adults are also in the class, so our policy is that adults may not attend student sessions.)
Breakfast and lunch: Everyone will receive breakfast and lunch at no extra cost. If you have special dietary needs, please bring a sack lunch.
Student Permission Slip: MUST be completed by parent or guardian and may contain no strikeouts. This is NOT a bus permission slip.
My daughter

may participate in the EYH Conference on Saturday, February 21, 2015.

I understand that while in attendance she will be asked to evaluate the conference and may be photographed or videotaped for EYH promotional purposes.

During the conference, I may be reached at

Legal Signature

(Phone)
Please print name

If I cannot be reached in the event of an emergency, the following adult may act on my behalf:
Print Name

Phone
REGISTRATION IS NOT COMPLETE UNTIL SIGNED PERMISSION SLIP AND PAYMENT ARE RECEIVED