Welcome to the Greater San Antonio
Young Women's Leadership Symposium


Student Registration


Deadline for submission is Friday, October 30, 2015.
 
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)		  
     
Home Address
(Please include City, State and Zip Code)		  
     
Work Phone (Required)  
     
Home Phone (Required)  
     
Cell Phone (Required)  
     
Young Woman's 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)  
     
   

Download the Registration Form (PDF)

By completing this online form, I am submitting the registration and authorizing participation for my Young Woman (Student) at the 2015 Young Women's Leadership Symposium in San Antonio, TX on November 14, 2015. 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 2015 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.