30th
Western Illinois University
National Girls and Women in Sports Day Celebration
Registration Form for Girl Scouts
Girls ages 9-14 are invited to participate in the
celebration at Western Illinois University:
Saturday, January 30, 2016
1:00 p.m. – 6:30 p.m.
Brophy and Western Hall
Please print clearly all information requested below and mail w/ payment and waiver form for each girl to:
WIU Women’s Center, Multicultural Center 209, 1 University Circle, Macomb, IL 61455
Phone: 309-298-2242 Email: womenscenter@wiu.edu
(checks payable to WIU Women’s Center)
Troop: __________________________________ Town/County: ___________________________________
Leader:________________________________ Phone #:___________________ E-mail: __________________________
Adult(s) attending the activities with the girls (if any) NOTE: There will be volunteers from WIU supervising the girls at the event
Name: ______________________________ Day Phone #: ____________________ E-mail: _____________________
Address: _____________________________ City: ________________________ State: ___________ Zip: ________
Name:______________________________ Day Phone #: ____________________ E-mail: ______________________
Address: _____________________________ City: ________________________ State: ___________ Zip: ________
Names/Ages of girls attending: T-shirt Size** (please circle)
Names/Ages of girls attending: T-shirt Size** (please circle)
________________________ YM YL AS AM AL AXL
________________________ YM YL AS AM AL AXL
________________________ YM YL AS AM AL AXL
________________________ YM YL AS AM AL AXL
________________________ YM YL AS AM AL AXL
________________________ YM YL AS AM AL AXL
________________________ YM YL AS AM AL AXL
________________________ YM YL AS AM AL AXL
________________________ YM YL AS AM AL AXL
________________________ YM YL AS AM AL AXL
**Youth Medium, Youth Large, Adult Small, Adult Medium, Adult Large, Adult Extra Large**
Total Number of Girls Attending ___________ x $__$10______ each = $____________
Total Amount Enclosed = $____________
Registration Fee includes a t-shirt, snacks, goodie bag, pizza, and admission to the WIU Women’s Basketball game.
NOTE: General admission tickets to the basketball game may be purchased for $8 at the Will Call window in Western Hall by parents
or others who would like to attend the game but who will not be attending the activities earlier in the day.
Food allergies or special needs: ______________________________________________________________________
Parent/Guardian Signature: _______________________________________________ Date________________
*Registration forms are due by January 15, 2016, but later forms may be accepted*
Registration forms received by January 15 will receive a T-Shirt at the event
Any registration forms received after January 15 will receive a T-shirt at a later date