REGISTRATION FORM

Registration: Deadline is Friday, April 16th Fee: $15.00

Please make checks payable to UIC.

No refunds after April 19th. Late registration fee: $20.00

Return this page to Office of Women's Affairs, M/C 363, 802 University Hall

*Note: To make registration returns more convenient for people working on the west side of campus, please drop off your registration(s) with payment at: UIC Hospital (1740 W. Taylor), First Floor, Suite 1500. Attn: Kim Kramer or Maria Flores.

Money must accompany registration form.

No emailed or faxed registrations will be accepted.

Sponsor’s Name: _____________________________________

Department: ________________________________________

Campus phone# and Mail Code: ___________________________

Girl’s Name:_________________________________________

Girls must be between ages 9~15

Name & campus phone# of person picking up the girl:

__________________________________________________

*It is our policy that all participants must leave the event accompanied by their sponsor or an adult.

If a participant has a disability and requires an accommodation, please contact Alana Stegich at (312) 413-1025 at least one week in advance of the event..

Will sponsor be attending the morning program? Yes No

Did you attend last year ?_____Yes _____No

Pre-registration required. Space is very limited

Mark 1st, 2nd, and 3rd choices of activities

_____UIC Police	_____ Nursing School
_____Theater[CLOSED]	_____Graphic Design[CLOSED]
_____ Physics	_____Pharmacy
_____ Engineering	_____Photography[CLOSED]
_____ Computer Center	_____Comic Book Design
_____ Nursing at the ER [CLOSED]	_____Bioengineering

[ ] I would like to be a Chaperone

[ ] I would like to help with registration