Mat-Su Program July 31-August 5, 2017 Palmer High School, Palmer, AK
Registration Form Student Information: Student First Name ________________________
M.I. ______ Last Name ____________________________
Birth date ____________________
Male
Female
Mailing Address _______________________________________ City ________________ State ____ Zipcode _________ Home Phone _____________
Student Cell _____________
High School ________________________________ Academic Grade you will complete in May 2017
Tshirt Size 9th
Student Email _______________________________ S 10th
M
L 11th
XL
2XL
3XL
12th
How or where do you hear about Alaska Business Week? _____________________________________________________ Parent/Guardian Information: First Name ________________________ Last Name ____________________________ Relationship __________________ Primary Phone ___________________ Alternate Phone ___________________ Email Address _______________________ Parent/Guardian #2 Information: First Name ________________________ Last Name ____________________________ Relationship __________________ Primary Phone ___________________ Alternate Phone ___________________ Email Address _______________________ Acceptance Email Address: Please provide an email address that will be checked regularly and will not be changed until after the program is completed. All correspondence will be emailed directly to this address. Email Address________________________________________ If accepted I agree to make a sincere effort and push myself to grow during the week Student Signature _______________________________ Date_______________ I give my permission for my student to attend Alaska Business Week Parent/Guardian Signature _______________________________ Date_______________ Please submit all application forms to
[email protected] The Mat-Su ABW program has limited slots available. After your forms have been received you will be notified of your acceptance status. Students accepted will be emailed with additional information about the program and additional program forms. Please note submission of these forms is commitment to attend the program if accepted. If extenuating circumstances arise and you are unable to attend please let us know before June 23 so we are able to fill your slot with another student. Alaska Business Week, 471 West 36th Ave., Suite 201, Anchorage, AK 99503 ABW Executive Director: Nicole Schuh Phone: (907) 278-2744 Email:
[email protected] Website: alaskachamber.com/ABW
