Student Program Registration Form

Registration Deadline for Individuals: March 25, 2009
Registration Deadline for Groups of less than 10: March 25, 2009
Registration Deadline for Groups of 10 or more: March 21, 2009
Student Registration Fee: $5.00 (non-refundable) in advance, $10.00 on-site (if space available). Fee may be waived by having your teacher sign below.
Return registration form & fee to:
   CEYH c/o NMNWSE 		    Make checks payable to:
    Expanding Your Horizons (EYH).
Your check is your receipt.
Please Print Carefully. Thanks!

Last Name___________________________________    First Name_______________________________

Address______________________________________________________________________

City_______________________________________________________    Zip______________

Phone________________________    School____________________________________________

Grade (circle one):

6

7

8

9

10

11

12
From among the workshop catagories listed, choose your top three categories of interest.
Your workshops will be assigned based your interest.
Rank
1-3		Category
  Medical/Life Sciences
  Engineering/Technology
  Mathematics/Computer Science
  General Science
   
Other: ______________________________________________________________

If the $5 fee presents a financial hardship, please have your teacher sign here:

______________________________________________________________________
Your teacher's signature waives the registration fee.

How did you hear about the EYH Conference?_____________________________________

Please indicate any special assistance or help needed, such as wheelchair access:

 Fine Print: <Registration for this conference constitutes the granting of permission for the use of your photograph in publicity for future conferences. EYH is not responsible for, and cannot supervise students who fail to attend assigned sessions and scheduled activities. >
 
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Licensed by NMNWSE from the national EYH Network.