Evansville, Indiana Branch Why a Science and   Technology Conference? Career Exploration Workshops Workshop Schedule Adult Program Registration Form Workshop Information Directions to Ivy Tech Workshop Sponsors Questions? Contact Us. Home

No.______ Registration Form Expanding Your Horizons Workshop Date: Saturday, March 8, 2008 Registration Fee: $10** – Make check payable to AAUW. Location: Ivy Tech Community College 3501 First Avenue Evansville, Indiana Registration Deadline: When Classes Fill Pre-registration is REQUIRED. No confirmation will be sent. Return registration form & check to: Wilma Orton / EYH 792 Senate Avenue, Evansville, IN 47711 For further information, call Wilma Orton 812-422-5198 or Email - wjorton@insightbb.com Carolyn Kreighbaum 812-868-0163 ------------------------------------------------------------------------------ Please Print Clearly Student Name_______________________________ Address____________________________________ City____________________ST_____ZIP________ Phone_____________________________________ Email______________________________________ School____________________________Grade____ _______________________________________________ Parent/Guardian Signature Date __________________________________________ Parent/Guardian Print Name (_____)____________________________________ In case of emergency, please call Please indicate any special assistance or help needed, such as wheelchair access. Please print the LETTER of your top FIVE choices of the Career Exploration Workshops. You will be assigned to THREE workshops. Every effort will be made to meet your requests on a first-come, first-serve basis. Changes will not be made on the day of the conference. Please register early. 1st Choice___2nd Choice___3rd Choice___ 4th Choice___ 5th Choice___ Parent/Guardian Permission Under adult supervision, my child will participate in workshops designed to stimulate her interest in science and math as part of the Expanding Your Horizons Workshop on Saturday, March 8, 2008 at Ivy Tech Community College campus. I have read the workshop descriptions and understand that my child may come in contact with live plants or animals, chemicals, electrical or computer equipment. By permitting my child to attend, I accept responsibility and agree to hold Ivy Tech, its employees, and Expanding Your Horizons volunteers harmless from all claims for injury or damage. I grant permission for my child to receive emergency medical care by qualified personnel while attending the workshops. I also grant permission for photography or video of my child during the event for use in Expanding Your Horizons publicity.