REGISTRATION FORM

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

Registration: Deadline is Friday, April 22nd Fee: $15.00

Please make checks payable to UIC.

No refunds after April 25th. Late registration fee: $20.00

*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.

Payment must accompany registration form.

No emailed or faxed registrations will be accepted.

Sponsor’s Name: _____________________________________

Department: ________________________________________

Email: ________________________________________

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

Please mark 1st, 2nd, and 3rd choices of activities

_____UIC Police	_____ Nursing School
_____Theater	_____Early Childhood Ed
_____ Physics	_____Dentistry
_____ Library	_____Pharmacy
_____ Computer Center	_____Photography
_____ Nursing at the ER	_____Comic Book Design
_____Designing Daughters	_____Archaeology

[ ] I would like to be a Chaperone and accompany my girl on her tour site  

[ ] I would like to help with registration