EmailMe Form - O.M.G Conference REGISTRATION FORM

Name *

First Last

AGE *

D.O.B *

MM / DD / YYYY

ex. 02/04/1999

Phone *

### - ### - ####

Address *

Street Address City State / Province / Region Postal / Zip Code

T-Shirt Size *

Parent/Guardian Name *

First Last

Email *

Emergency Phone *

### - ### - ####

Did you attend last year's conference? *

What positive thing do you look forward to from this year's conference? *

What Conference Are You Attending? *

*

I grant permission to the Outstanding Mature Girlz Organization to use photographs and/or video of the above named participant from the OMG Conference in publications, news releases, online, and in other communications related to OMG's mission.*

PLEASE NOTE: (The OMG Conference is an EMPOWERMENT event that has some subject matter discussions around HIV/AIDS prevention, pregnancy prevention, and overall young women's health and wellness)

By clicking submit, I acknowledge that I am 18 years or older, and/or the parent or legal guardian of the above mentioned participant, and I hold Outstanding Mature Girlz Org., and all its entities harmless from any injuries, sickness or death occurred to participant named above, while attending The OMG Conference.

Parent/Guardian Signature Required *

Clear