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UWEVAL 2011 – Registration Form [Female] “High Society: First Lady” Name: _______________________________________________________________ Address: ____________________________________________________________________________ Telephone Number: ___________________ (H) _______________________ (C) *Specify mobile carrier here to receive messages via cell-phone {

}

Email Address: _______________________________________________________________

Allergy:____________________

Special Condition: ____________________

Kindly CIRCLE the applicable options below. Faculty: Social Sci.

Pure & Applied

Med Sci.

Law

Humanities

N/A

Top/Shirt Size: XS

S

M

L

XL

XXL

S

M

L

XL

XXL

Yes

No

Bottom Size: XS Head Piece:

$20 Single

$10 Group Special*

*Groups of 5 or more persons must make down payment at time of registration for special to apply. No additional persons can be added to group after initial registration. **PATRON KINDLY INITIAL BESIDE EACH PAYMENT**

Total Cost Of Package

Payment #1

Payment #2

Total Money Received

Customer Signature

IR Representative Signature


Island Roots Carnival Registration Form - Females