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2010 Students Registration Form

Print this form using your computer's print button.
Fill out form and mail it with your Registration Fee to the address below.

$15 Early Bird Registration Fee included (on or before March 6)

$20 Registration Fee included (postmarked after March 6)

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 top six (6) choices in the boxes below in the order of your preference. Every effort will be made to meet you requests on a first-comee, first served basis. Click here to see the list of workshops.

1st

2nd

3rd

4th

5th

6th
To request the same workshop session with a friend, write her name here and send your forms together in the same envelope. We cannot guarentee placement in the same session.

Friend's Name:

Parent/Guardian Permission: (This MUST be completed and signed.)
I give permission for my daughter to attend the EYH Conference on March 20, 2010, and give permission for an adult conference organizer to seek emergency medical treatment for her if I cannot be reached.

Parent Signature:
Emergency contact during conference:
Contact Name
Contact Phone
 

2010 Adults Registration Form

For adults who plan to attend EYH

Name

  

Address

  

City, State Zip

  

Phone
Home Cell Work
     

 

Fees and Registration: There is a fee for each student or adult who attends.
Student/Adult Fee: $15 Early Bird Fee before March 6, 2010.
Student/Adult Fee: $20 Fee after March 6, 2010.

  • Pre-registration is required. Registration is limited to 325.
  • Workshop preferences are honored in the order they are received.
  • Confirmation will be mailed to you with directions and a map.
  • Need-based fee waivers are available through Jean Coontz.
  • Special needs: Please let Jean Coontz know by February 27 if any special accommodations are required.
  • Please notify Jean Coontz if you do not want your child to be photographed at this event.

Mail to:

Expanding Your Horizons
c/o Jean Coontz

Space is limited!

Register early!

 

815 S. Feldkamp Ave
Springfield, IL 62704

 

For more information, call Jean:

(217)787-8078

 

Want to see a video about EYH conferences? Go to the Web site www.expandingyourhorizons.org and click on New!! EYH Movie. Much of the movie was filmed in Springfield last year!

Download the 2010 Expanding Your Horizons brochure in PDF format

 

 

 

 

 

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