Workshop Registration Form | Expanding Your Horizons Workshop | New Mexico Network for Women in Science and Engineering

Permission Statement My child is at least in 7th grade and has my permission to attend Expanding Your Horizons. I give my permission for her to use public transportation, if necessary, to attend the workshops. I give my consent for her to be photographed for publicity purposes. In the event of an emergency while my child is attending EYH, I give my permission for her to receive emergency medical treatment and care. Registrations must be signed by a Parent or Guardian to be considered. Special accommodations must be listed above.


Workshop Registration Form Click here for pdf version. *required field
First Name:
Last Name:
Address1:
Address2:
City:
State:
Zip Code:
Phone (xxx) xxx-xxxx:
Email:
School:
Grade:
Teacher or Adult Sponsor:
Please select your interest(s) in the STEM and related fields :
Which topic(s) would interest you most during the the EYH Conference?
Have you attended an EYH Conference in the past?:
List any special needs or accomodations:
List any allergies:
Permission Statement My child is at least in 7th grade and has my permission to attend Expanding Your Horizons. I give my permission for her to use public transportation, if necessary, to attend the workshops. I give my consent for her to be photographed for publicity purposes. In the event of an emergency while my child is attending EYH, I give my permission for her to receive emergency medical treatment and care. Registrations must be signed by a Parent or Guardian to be considered. Special accommodations must be listed above.
I have read and agree to the permission statement:
Parent or Guardian Name:
Daytime or Cell Phone Number (xxx) xxx-xxxx::
Emergency Contact Name:
Relationship to EYH Participant:
Daytime or Cell Phone Number (xxx) xxx-xxxx:

Workshop Registration Form Click here for pdf version.

Workshop Registration Form
Click here for pdf version.