Young Women’s Empowerment Summit | Texas Leadership Consortium

"*" indicates required fields

Event
2024 Gulf Coast Young Women's Empowerment Summit

Venue*

Student Information

School*

Name*

Prefix First Last

Personal Pronoun

Age*

Grade*

Address

Street Address Address Line 2 City State ZIP Code

Phone

Career Interests

Dietary Needs (if necessary)

Medical Needs (if necessary)

Accommodations (if necessary)

Parent or Guardian Information

Name*

Prefix First Last

Email*

Relationship to Student*

Address*

Street Address Address Line 2 City State ZIP Code

Home Phone

Cellular Phone*

Work Phone

How did you hear about us?*

Terms and Conditions*

I agree

By completing this form, I am submitting the registration and authorizing participation for my young woman (student/young adult) at the Young Women's Empowerment Summit. This acknowledges that as the parent or guardian of the young woman (student/young Adult attendee), transportation too and from the summit will be my sole responsibility. I take full responsibility and waive and release from any liability all summit organizers, all summit sponsors, and all parties of the Texas Diversity Council. Student participation in the Young Women's Empowerment Summit is fully voluntary. I also grant permission for my young woman (student/young adult) to be included in group event photos.

CAPTCHA

Phone

This field is for validation purposes and should be left unchanged.