Registration Form LATE REGISTRATION
After Registration deadline conference t-shirts and lunch will be based on availability on a first come basis.

Payments can be submitted via phone, fax, or mail

Please Fax Credit Card authorization form to (713)743-6419 or
Call Joseph Secrest at (713)743-8469 or Ana Malagon (713) 743-1621 to make credit card payment over the phone or
mail check to:
Joseph Secrest
University of Houston Campus Recreation & Wellness Center
4500 University Blvd.
Houston, TX 77204

Email address *
First Name *
Your answer
Last Name *
Your answer
Gender *
Phone *
Your answer
Institution *
Your answer
Director's Name or Email *
Your answer
Position *
Required
T-Shirt Cut (BASED ON AVAILABILITY FOR LATE REGISTRATION) *
T- Shirt Size (BASED ON AVAILABILITY FOR LATE REGISTRATION) *
Dietary Preference (BASED ON AVAILABILITY FOR LATE REGISTRATION) *
Payment Option *
A copy of your responses will be emailed to the address you provided.
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