Adult Program Registration Form

Registration Deadline for Groups of 10 or more: March 21, 2009
Registration Deadline for Groups of less than 10: March 25, 2009
Registration Deadline for Individuals: March 25, 2009
Adult Program Registration Fee: $5.00 (non-refundable) in advance, $10 on-site (if space available)
Return registration form & fee to:
       Make checks payable to:
    Expanding Your Horizons (EYH).
Your check is your receipt.

Please Print Carefully. Thanks!

Last Name_____________________________________________

First Name_____________________________________________





Please indicate which program you wish to attend (see Adult Program for more information):
______STEM-115 Course targeting Teachers, Counselors, and other Educators.
             _____For Credit       _____Auditing
______Informational Sessions targeting Parents and other Accompanying Adults

Would you be willing to assist with EYH in any way next year?

______Yes       ______No

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.