Purdue Research Park [ Entrepreneur Academy ]

The Entrepreneurship Academy

July 27, 2008 - August 1, 2008

Permission Form - Please return no later than July 13th.

All information on this form MUST be completed and returned in order to attend the academy.

Minor’s Name:
Parental/Legal Guardians Signature:
Address:
City, State and Zip:
Telephone:

T-Shirt Size:

Medical Conditions:
Current Medications:
Allergies:
Dietary Needs:

EMERGENCY CONTACT INFORMATION

Contact Name:
Relationship to Participant:
Day Phone:
Night Phone:
Cell Phone:

AWARDS LUNCHEON: Friday, August 3, 2007

I will be attending:
Name of Attendee(s):

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