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Northern Utah Family Empowerment Expo
Thursday May 12, 2011     5:00 - 8:30 pm
Ben Lomond High School
1080 9th Street
Ogden, UT 84404

* Adult 1 First Name: * Last Name:
* Adult 2 First Name: * Last Name:
Mailing Address:
City: Zip Code:
Phone: Email:
Language(s) spoken at home:
Will you need translation for the sessions (Spanish)? Yes No
Do you need assistance with transportation? Yes No
(transportation will be provided for anyone 5 and older)
Will you have children attending the expo with you? Yes No
Do you authorize and give permission for your, your children(s), and other family members name, age, and pictures at this activity be utilized in school or district publications, news media, and other publications?
Yes No (If no, please go to the registration table at the expo.)
Questions? Please call (801) 737-7367 (Spanish) or (801) 737-7323 (English)
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