MA 2010 Young Women's Program form

1. MA 2010 Young Women's Program Form

The MA Conference for Women is once again pleased to offer our Young Women's Program to junior and senior high school students. Attendance for these young women and their chaperones is free.

To request registration for a group of young ladies, please complete this form. There are a limited number of spaces available, and they are awarded on a rolling basis as requests are received.

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* 1. Please provide your contact information

Contact Name: *

Organization Name: *

Organization Address: *

Address 2:

City/Town: *

State: *

ZIP: *

Contact Email Address: *

Organization Phone Number: *

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* 2. Website Address:

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* 3. Please indicate the number of young women you would like to bring to the Conference. Please note, Young Women's Program participants MUST be juniors or seniors in high school.

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* 4. Please indicate the number of chaperones you would like to bring. Although the ratio is flexible, the Conference encourages one chaperone for every five young ladies.

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* 5. If your organization has participated in the Young Women's Program before, please indicate the year.

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* 6. Please contact me about having a booth in the exhibit hall.

Yes

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* 7. By signing this form, I commit my organization to sending the specified number of young women and chaperones to the conference on December 9th.

Name

Date