WISE Symposium 2017 Registration

Churchill High School's Women In Science & Engineering
welcomes all high school students to our 5th annual WISE Symposium!
Saturday, February 25, 2015
Churchill High School, 1850 Bailey Hill Rd.
10 a.m to 4 p.m.
Check-in begins at 10:00 a.m.
Welcome begins at 10:30 a.m.
Snacks and a light meal will be served!

This year we welcome our keynote speaker Olenka Cullinan, a nationally recognized Science, Technology, Engineering and Math (STEM) representative, and founder of Rising Tycoon, a success program for future leaders, to empower young people become CEOs of their lives.

IMPORTANT THINGS TO KNOW! Please fill out the registration form carefully. This year you will be selecting your workshops at the event. But we still need to know who is coming and how many. Most workshops are limited to 15 participants on a first come, first served basis. Don't worry! You will have more than one opportunity to attend a workshop.

HINT #1: Please click on the drop down menus in the registration below to see all your choices.

HINT #2: YOU MUST BRING YOUR SCHOOL ID WITH YOU ON THE DAY OF THE SYMPOSIUM

Workshop descriptions and the schedule are at the bottom of this form.

••• Please leave school colors, athletic wear, etc. behind and join us in an atmosphere of curious exploration in science and engineering. •••

***** SUBMITTING YOUR REGISTRATION MEANS YOU AGREE TO ABIDE BY THE BEHAVIOR GUIDELINES SET FORTH BY THE 4J STUDENT RIGHTS AND RESPONSIBILITIES HANDBOOK. It also means you and your parent/guardian acknowledge that any photos taken may be used by media including print and web promotions. *****

Technology problems? Event Questions? Email: Mary Beth Hepp-Elam, Program Coordinator at elam_m@4j.lane.edu

Please complete the following information:

Participant Last Name:

This is a required question

Participant First Name:

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Student ID#

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Phone #:

In case of an emergency

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E-mail address

Please supply an e-mail you check regularly. E-mails are only used for WISE purposes and are not shared with any other entity.

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Grade Level:

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School Name:

If you don't see your school name, please check "other" at the bottom of the list.

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If you chose "Other," please write the name of your school in the box below.

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Purchase a T-Shirt!

We have unisex sized T-Shirts in periwinkle blue with the black WISE 5th Anniversary logo on the upper left shoulder. Indicate your size, then bring your $5.00 cash or a check made payable to Churchill High School to the event. Your T-Shirt will be waiting for you at registration! Supply limited to first ordered, first served.

WISE T-Shirt

This year's T-Shirt is lavendar with black ink.

Yes! I want to purchase a WISE T-Shirt for $5. I will bring cash or a check made payable to Churchill High School or cash to the Symposium!

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Doante Today!

Yes! I want to donate to this great symposium to keep it running into the future. Make your check payable to: Churchill High School and indicate WISE 2017 in the memo space. Send your check or money order to WISE/Churchill High School, 1850 Bailey Hill Rd. Eugene OR 97405

YES! I will donate and send my check/money order to the above address.
Yes! I will donate on the day of the Symposium!

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