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 *
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Last Name *
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Phone *
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Institution *
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Director's Name or Email *
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Position *
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T-Shirt Cut *
T- Shirt Size *
Dietary Preference *
I plan to take advantage of the overnight accommodations at UH. *
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