May 3, 2019 at Fox Valley Technical College, Appleton WI

Thank you so much for attending the Young Parent Conference, we are looking forward to another great year! Please answer the following questions to register for the conference and make your speaker selections. Please note that you are selecting your top choices for speakers, and will receive your final schedule on May 3rd reflecting these preference. You will not be attending all sessions due to time constraints. Please register all participants separately! If you have questions or have any issues with this survey form, please call Lori Casey at 920-739-4226, ext. 127 or email at lcasey@familyservicesnew.org. 

*Please note there is no childcare at the conference and other arrangements should be made for your kids.

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* 1. Full Name:

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* 2. County of Residence:

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* 3. E-mail Address:

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* 4. Phone:

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* 5. I: (Check all that apply)

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* 7. Name of Adult Chaperone (chaperone is required for students under the age of 18)

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* 8. I have attended the Teen Parent Conference before?

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* 9. Please indicate your top preferences for our first breakout session (1=top choice, 5=last choice):

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* 10. Please indicate your top preferences for our second breakout (1=top choice, 4=last choice):

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* 11. Please indicate your top preferences for our third breakout session (1=top choice, 5=last choice):

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* 12. Please indicate your top preferences for our fourth breakout session (1=top choice, 5=last choice):

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* 13. Please indicate your top preferences for our fifth breakout session (1=top choice, 3=last choice):

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* 14. Where did you hear about the conference?

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* 15. Will you be bringing a guest other than your chaperone? (Lunch count)

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* 16. Is there another participant you would like to attend your sessions with? If yes, list full name below.
*All parents should register separately even if spending the day together

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