EOSH 2025 Participant Acceptance Form

EOSH Confirmation 2025

Full Name *

Preferred Name: *

Please confirm your acceptance for attending the Environmental Occupational Safety & Health Institute May 12—May 16, 2025. *

Yes, I will be attending

No, I won't be attending

Will you need accommodations? *

Yes—Dual occupancy dorm rooms with bedding provided

No

Tshirt size *

Small

Medium

Large

X-Large

XX-Large

Mailing Address *

City *

State * State

Zip Code *

Email *

Do we have permission to use your photo in marketing materials to promote the EOSH? *

Yes

No

Emergency Contact: *

Emergency Contact Phone Number: *

Relationship to you? (Parent, Aunt, Neighbor, etc.) *

Do you have any food allergies, dietary restrictions, medical conditions, accessibility needs, or anything else we need to know to make your stay better?

I understand that participation in this program requires adherence to all policies and guidelines set forth by the program organizers. I agree to: Attend all scheduled sessions and activities, follow the university's code of conduct and housing regulations, and communicate any changes to my attendance status as soon as possible. By typing my full name below, I agree to comply with the program guidelines.

Name

First Name

Last Name

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