Registration
Student Registration
1. Complete the registration form on-line.
2. Print two copies of the completed form using the print button at the bottom of the form.
(one copy to mail and one copy for your records)
3. Mail the signed copy with a check or money order for $15.00 per girl payable to:
Mary Pirkl - Attn: GEMS
PO Box 86
Kampsville, IL 62053-0086
The cost, which is non-refundable, includes workshop materials, snacks and a T-shirt.
Scholarships are available but must be processed through the girl's teacher
First Name:
Last Name:
Phone:
Address:
City:
State:
Zip:
School:
Select an item
Alton Middle
Brighton North
Brussels Elementary
Bunker Hill
Calhoun Elementary
Carlinville Middle
Catholic Children's Home
Carrollton Grade
Central Baptist
Collinsville Christian Academy
Coolidge Middle
Dorris Intermediate
East Alton Middle
Evangelical Elementary
Faith Lutheran
Gillespie Middle
Girard Jr/Sr High
Good Shepherd Lutheran
Greenfield Elementary
Greenville Jr High
Grigsby Middle
Grantfork Upper
Harris
Highland Elementary
Highland Middle
Holy Cross Lutheran
Holy Family
Holy Ghost
Illini Middle
Lewis & Clark Jr. High
Liberty Middle
Lincoln Middle
Lovejoy Middle
Madison Middle
Medora
Meissner Junior High
Mississippi Valley Christian
Montessori Children's House
Montessori
Mt. Olive Grade
North Greene Middle
Northwestern Elementary
Northwestern Jr/Sr High
Our Lady Queen of Peace
Roxana Jr. High
Shipman
Southwest Middle
SS Peter & Paul - Alton
SS Peter & Paul - Collinsville
Staunton Elem/Jr High
St. Ambrose Parish
St. Boniface Catholic
St. Elizabeth
St. Francis
St. John the Evangelist
St. Mary's - Brussels
St. Mary's - Alton
St. Mary's - Edwardsville
St. Michael's
St. Norbert's
St. Paul Catholic
St. Peter Lutheran
Triad Middle
Trinity Lutheran
Trinity - St. Paul Lutheran
Venice Elementary
Virden Middle
Westminster Christian Academy
Wilbur Trimpe Jr. High
William Bedell Center
Yvetter-Young
Zion Lutheran - Bethalto
Zion Lutheran - Staunton
Other
Email:
Grade:
6th
7th
8th
Home Schooled
Previous Attendance:
First Time
1 yr
2 yrs
All girls will be enrolled in "Welcome to the Real World" as 1 of their 3 workshops. List 3 workshops from the "Workshops" page that you would enjoy attending. One workshop will be one of your choices; the other will be assigned.
Special Needs:
Comments/Instructions:
Workshop Choices:
Please do not include
Welcome to the Real World
1.
2.
3.
Parent/Adult/Teacher Registration
1. Complete the registration form on-line.
2. Print two copies of the completed form using the print button at the bottom of the form.
(one copy to mail and one copy for your records)
3. Mail the signed copy with a check or money order for $15.00 attendee (parents, grandparents, and other concerned adults) payable to:
Mary Pirkl - Attn: GEMS
PO Box 86
Kampsville, IL 62053-0086
The cost, which is non-refundable, includes workshop materials, snacks and a T-shirt.
5 CPDU's will be available for Teachers.
Title:
Parent
Teacher
Adult
First Name:
Last Name:
Phone:
Address:
City:
State:
Zip:
Email:
Previous Attendance:
First Time
1 yr
2 yrs
Special Needs:
Comments:
Workshop Choices:
Please do not include
COLLEGE EXPLORATION & MORE! or TEACHERS' SPECIAL
1.
2.
3.
Copyright © G.E.M.S.
