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UNIVERSITY OF DAYTON - DOC 1

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					                            Women in Engineering
                          Summer Camp Registration
                                         July 10-15, 2011
                                                                             Tuition Fee $600
Name:                                                                          Date:
Address:
City                                          State                            Zip:
Phone                                   Email Address:
County of Residence:

High School Information
High School:                                                 Year of Graduation:
Grade Point Average:                                              Class Rank:
High School Signature:
                      (Signature and Telephone Number of Guidance Counselor)

Parent signature:
Please indicate the size for your camp T-shirt:    Adult      S        M      L        XL         XXL

Payment Method:
   Check enclosed, payable to: University of Dayton Women in Engineering
Credit Card:          Visa        MasterCard            Discover           American Express
                   Acct. #:                                                    Exp.:
                   Security Code:                     (3-digit on the back of your credit card)

                   Signature:                                                  Amt$:
                                Mail application and tuition fee to:
                                        Annette Packard
                                     University of Dayton
                                     School of Engineering
                                       300 College Park
                                    Dayton, OH 45469-0228
                                        (937) 229-3296
                                       wie@udayton.edu

				
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