Welcome to the Coastal Bend
Young Women's Leadership Symposium



Student Registration

Deadline for submission is Thursday, October 4, 2018.

 

Name of High School (Please insert the name of your Student's school)  
     
 
     
Young Woman's Last Name (required)  
     
Young Woman's Age (required)  
     
Young Woman's Grade Level (required)  
     
Parent's/Guardian's First Name (required)  
     
Parent's/Guardian's Last Name(required)  
     
Parent's/Guardian's Email Address (required)  
     
Relationship to Student (Parent, Grandparent, Legal Guardian)  
     
Address (include city, state and zip code)  
     
Work Phone (required)  
     
Home Phone (required)  
     
Cell Phone (required)  
     
Email Address (required)  
     
Please include any
special dietary needs for the young woman(if any)
 
     
Please include any
medical needs for the young woman(if any)
 
     
     
   

 

By completing this online form, I am submitting the registration and authorizing participation for my Young Woman (Student) at the 2018 Young Women's Leadership Symposium in Corpus Christi, TX on October 6, 2018. This acknowledges that as the parent or guardian of Young Woman (Student) attendee, transportation to and from the Symposium will be my sole responsibility. I take full responsibility and waive and release from any liability all Symposium organizers, all Symposium Sponsors, and all parties of the Texas Diversity Council. Student participation in the 2018 Young Women's Leadership Symposium is fully voluntary. I also grant permission for my daughter (or granddaughter, student) to be included in group event photos.

 

Coastal Bend Links

 

Sponsors

To be determined