Girls Empowerment Registration Form 2023 Scholarship

Conference Registration Form

A Letter to My Daughter
WWW.GIRLSEMPOWERMENTCONFERENCE.ORG

“Loving Me More, Being a Better You”
Full Name*

First NameLast Name
Name

First NameLast Name
Name

First NameLast Name
Name

First NameLast Name
Name

First NameLast Name
E-mail*
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

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Permission and Acknowledgment:

I, the undersigned, give permission for my child, to attend the Girl's Empowerment Conference session on Infant Maternal Mortality. I understand that this event will cover sensitive health topics and may involve group discussions.

I also acknowledge that the conference organizers will ensure a safe and educational environment for all participants.
Attend

YesNo
Diaper Sizes( Select if Needed)

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Wavier of Liability

In consideration of accepting my attendance . I intend to be legally bound, to hear buy for myself, my heirs, my executors and administrators wave and release All rights and claims for damages accrued against the city of Cayce, suffered by me too and from participating or related to the girls empowerment conference event sole responsibility. In addition to the named above are not responsible for vehicle or personal property damages or theft. I assume all risk by confirming and agreeing.I, also agree to obey all traffic signals, laws, Signs, and postings in the building and parking lot of Mt.Zion of Cayce. Refund policy due to the nature of this event shall be non-refundable.

Please sign, signature indicates your agreement to the Wavier of Liability.
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Conference Registration Form

WWW.GIRLSEMPOWERMENTCONFERENCE.ORG