EmailMe Form - Group Registration Form

EmailMeForm

Participant's Name (1) *
First Last
Birthdate *
MM / DD / YYYY
Participant's Name (2) *
First Last
Birthdate *
MM / DD / YYYY
Participant's Name (3) *
First Last
Birthdate *
MM / DD / YYYY
Participant's Name (4) *
First Last
Birthdate *
MM / DD / YYYY
Participant's Name (5) *
First Last
Birthdate *
MM / DD / YYYY
Participant's Name (6) *
First Last
Birthdate *
MM / DD / YYYY
Participant's Name (7) *
First Last
Birthdate *
MM / DD / YYYY
Participant's Name (8) *
First Last
Birthdate *
MM / DD / YYYY
Participant's Name (9) *
First Last
Birthdate *
MM / DD / YYYY
Participant's Name (10) *
First Last
Birthdate
MM / DD / YYYY
Participant's Name (11)
First Last
Birthdate
MM / DD / YYYY
Participant's Name (12)
First Last
Birthdate
MM / DD / YYYY
Participant's Name (13)
First Last
Birthdate
MM / DD / YYYY
Participant's Name (14)
First Last
Birthdate
MM / DD / YYYY
Participant's Name (15)
First Last
Birthdate
MM / DD / YYYY
Participant's Name (16)
First Last
Birthdate
MM / DD / YYYY
Participant's Name (17)
First Last
Birthdate
MM / DD / YYYY
Participant's Name (18)
First Last
Birthdate
MM / DD / YYYY
Participant's Name (19)
First Last
Birthdate
MM / DD / YYYY
Participant's Name (20)
First Last
Birthdate
MM / DD / YYYY
Type of Group *
School
Church
Youth Sorority
Girl Scout Troop
Other
If OTHER, please list below
Guardian/Group Leader Information
Please enter Guardian/Group Leader information here
Name *
First Last
Birthdate *
MM / DD / YYYY
Phone *
### - ### - ####
Email *
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
With Parent/Guardian Permission *
I grant permission to the Outstanding Mature Girlz Organization to use photographs and/or video of the above named participant(s) from the OMG Conference in publications, news releases, online, and in other communications related to OMG mission.*
Signature *
Clear
PLEASE NOTE: by signing above, each participant's parent/guardian agrees and is FULLY aware that their child will be attending the O.M.G Conference, and you agree to take full responsibility of EVERY person listed in your group, and it is not the responsibility of O.M.G and its entities.
Date Time *
MM / DD / YYYY

Guardian/Group Leader Information