Registration Form
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 *
T-Shirt Cut *
T- Shirt Size *
Dietary Preference *
I plan to take advantage of the overnight accommodations at UH. *
Payment Option *
A copy of your responses will be emailed to the address you provided.
Please complete the captcha before submitting the form.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms