Climb High, Climb Far, Your Goal the Sky, Your Aim the Star.

2017 ASTRONAUT LACY VEACH DAY OF DISCOVERY
Saturday, October 28, 2017
8:00 am - 2:45 pm
at Punahou School

Astronaut Lacy Veach
INSPIRING, EXPLORING, DISCOVERING, VOYAGING, AND LEARNING
 
 
 

Linking voyages of exploration....past, present, future

2017 Registration Form
Eligibility: Students in grades 4-12, accompanying adults, and teachers of any grade level or subject.

NOTE: An adult must accompany any participant in grades 4-8 throughout the day (maximum of 2 students per adult).

Registration is free.

Instructions
Read the workshop descriptions. Fill out one registration form per participant. We need to know who you are and which workshops you choose.  Students: Please fill in all the boxes except for the two for teachers only. If you leave blanks we will ask you to go back and fill them in. One adult may accompany up to 2 students.  Teachers: Please fill in all the boxes. You may enter 00 for your age so you will not be prompted to fill in the name of an accompanying adult! You are asked to fill in your school name and grade twice. Thank you.


Who is Participating

Name of participant ( in this order: LAST name, First name ):

Mailing Address:

City:         Zip Code:

Home or cell phone:

Email address of parent or teacher (if available):

School attending:     Grade:     Age:

Gender: M   or   F

For Teachers only: School     Grade or subject:


Who is Attending With You

NOTE: An adult must accompany any participant in grades 4-8 throughout the day.

Name of accompanying adult :
If you are a classroom teacher, check here:   Your school :

Relationship to Student :

If same adult is accompanying another student registered separately, please list other student's name here (maximum of 2 students per adult) :

*for school groups: please contact Rene Kimura, rene@higp.hawaii.edu



Tell us about Last Year
What workshops did you attend at Astronaut Veach Day last year? (Either type the word none or type the topics):



What are your 2017 Workshop Selections

2017 Workshop session selections   (Type a workshop number in each box in your order of preference.)

First choice:         Second choice:         Third choice:

    Fourth choice:         Fifth choice:

By your registration for the Astronaut Veach Day, you grant to the Hawai‘i Space Grant Consortium, Punahou School, and the Hawaiian Electric Company, the right, in all media, to make, adapt and use for educational, promotional or other purposes of Hawai‘i Space Grant Consortium, Punahou School, and/or the Hawaiian Electric Company, any recordings or pictures made of you and/or your child and your activities at Lacy Veach Day of Discovery. You waive any right you or your child may have to review such recordings, or to receive any royalties or other compensation for the use of such recordings, pictures or materials.

       

When you click the Submit button, the information in this form will be sent automatically to discoveryday@spacegrant.hawaii.edu.

Seating will be limited. Reservations will be made on a first-come, first-serve basis. Workshop assignments will be based upon your selections and space availability.

A confirmation will be sent later to all registered participants. If you do not receive a confirmation within 10 days of registration, please email or call to confirm receipt of your registration form.

Contact Information:
Astronaut Lacy Veach Day of Discovery
Hawai‘i Space Grant Consortium
University of Hawai‘i at Mānoa
1680 East West Road, POST 501
Honolulu, HI 96822

phone: (808) 956-3138
email: discoveryday@spacegrant.hawaii.edu

September 1, 2017.