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You are cordially invited to the
11th Annual Future Leaders Forum for
Young Women
“Imagine the Possibilities”
Join some of the best and brightest young women in Richmond for a day of dynamic
speakers, mentoring, activities, networking, and fun!
When: Saturday, March 21, 2015
Registration starts at 9:30 a.m., Event begins at 10:00 a.m. and ends at 3:30 p.m.
Where: Capital One, 15000 Capital One Drive, Richmond, Virginia 23238
Complete the attached student information form, permission form, emergency release form, and
Personal Statement by February 27, 2014.
Sponsored by:
Questions?
Email [email protected]
or call (804) 284-5757
Capital One Public
Future Leaders Forum for Young Women
March 21, 2015
Student Registration Packet
Dear Student and Parent(s) or Guardian:
On behalf of Capital One and our Women’s Network, I’m thrilled to announce that registration is now open for the 11th annual
Future Leaders Forum for Young Women.
We invite you to register for this innovative program that has been inspiring young women and encouraging them to develop into
the leaders of tomorrow. We hope you’ll consider encouraging the young women in your household to register for this unique
experience.
About the Future Leaders Forum for Young Women
As in years past, this full-day event welcomes 300 young women in grades 9 through 12 to the Capital One campus, where they will
participate in activities designed to inspire, encourage and build their leadership skills. Through the day, students will enjoy:




Meeting and networking with young women from across the area
Hearing from dynamic speakers
Working with mentors to build their leadership skills
This year’s theme will be “Imagine the Possibilities”
Additionally, associates from Capital One will serve as mentors and role models of leadership throughout the day. They’ll be on-hand
to facilitate small group discussions and encourage students to fully participate in this opportunity.
Mark your calendar for Saturday, March 21
The Forum will be held on Saturday, March 21, 2015, on the Capital One campus at 15000 Capital One Drive, Richmond, VA 23238.
The doors open at 9:30 a.m. with the Forum starting promptly at 10:00 a.m. and ending at 3:30 p.m.
Thank you for supporting the Future Leaders Forum for Young Women, where each young woman will connect with her unique
leadership ability. We look forward to spending an inspiring day together.
Sincerely,
Judy Pahren, Executive Sponsor, Capital One Women’s Network
Patricia Astruc Jones, Capital One Women’s Network Lead
About Capital One
As Capital One continues to grow and diversify, our Shared Values remain constant—Excellence: how we perform as individuals,
teams and an organization, and Do the Right Thing: how we interact with each other, our customers and our community.
These Values are the foundation on which we’ve built our culture, our business, and our philanthropic program. Supporting our
communities brings our corporate Values to life. Through associate engagement, philanthropic partnerships and nonprofit board
leadership, we strive to be a meaningful part of the fabric of our communities.
Capital One Public
Future Leaders Forum for Young Women
March 21, 2015
Student Information
Registration deadline is Friday, February 27
To register, COMPLETE AND SIGN the Registration Permission / Emergency Medical Release Form—by Friday, February 27, 2015.
You can return it one of two ways:
 Scan and email to: [email protected]
 Mail: Capital One, Attn: Fran Davis; 12075-0100, 15000 Capital One Dr., Richmond, VA 23238
Student information:
Student Name: ____________________________________________________
(Please Print)
Student email address:
Address:
Street
Student Cell Phone:
(
City
Zip
)
Name of school student currently attends:
Grade:
How did student hear about this event? ____________________________________________________
(Please provide name and relationship)
Personal Statement:
To help our mentors provide the best experience possible, students should write a brief (1-2 paragraph) statement
about themselves and their goals after high school.
Capital One Public
Future Leaders Forum for Young Women
March 21, 2015
Permission Form
Please note: Capital One cannot permit participation in the Future Leaders Forum for Young Women without
receipt of this signed and fully completed Registration Permission, Emergency Medical Release Form and Student
Personal Statement.
Registration Permission
 I give permission for my child/minor,
, to attend the Future
Leaders Forum for Young Women on March 21, 2015, at Capital One’s West Creek Town Center in Richmond,
Virginia. I understand that I am responsible for arranging transportation to and from the Capital One West Creek
Town Center. Furthermore, by registering my daughter to attend this Forum, I also give permission for her to be
photographed at the event for inclusion, at Capital One’s sole discretion, in publicity related materials.
Emergency Medical Release Form
In the event of an emergency, I, (Please Print Parent/Legal Guardian Name)
, give
my permission for Capital One to provide first aid and to transport my child to a medical facility, if necessary. In case of
an emergency, if I, or the contact named below, cannot be reached personally, I consent to treatment of my child
under the supervision of and as deemed advisable by a licensed physician. I indemnify, release and hold harmless
Capital One Financial Corporation; and their affiliated corporations, subsidiaries, affiliates and other related entities;
their joint venturers, stockholders, successors, assigns, insureds, officers, directors, agents, representatives, employees,
contractors and other personnel, jointly and severally, and any first aid/medical care providers they may engage from
any claims related to my child’s participation in the Future Leaders Forum for Young Women; the provision of first aid
to, and emergency medical care and treatment of, my child; and including any accident, injury or death arising in
connection therewith.
Parent/Guardian contact information: (
)
Parent/Guardian email address: (Confirmation will be sent to this address, if provided):
Address:
Street
Phone: (
)
City
(
)
Home
)
(
)
Cell
If I cannot be reached, please notify:
Name
Name of Doctor:
Doctor’s Office Phone Number: (
Zip
(
Work
Phone
Hospital:
)
Insurance Company:
Emergency contact #: (
)
Policy Group #:
Special Medical or Dietary Needs (including allergies):
Parent/Legal Guardian Name (PLEASE PRINT)
Capital One Public
Parent/Legal Guardian Signature
Date
Future Leaders Forum for Young Women
March 21, 2015
Frequently Asked Questions
Who can attend this event?

High school women in grades 9–12 can attend the Forum. Space is limited and filled on a first come, first
served basis.
Where will the Forum take place?

The Future Leaders Forum for Young Women will be held on Saturday, March 21, 2015, from 9:30 am to 3:30
pm, on the Capital One campus at 15000 Capital One Drive, Richmond, VA 23238. Driving directions will be
provided in the confirmation packet once the student’s registration is received.
Where do attendees check in the day of the event?

There will be designated registration tables at Capital One.
Who are the mentors for the day?

Our mentors are female associates at Capital One. Mentors will share life and career experiences, teach effective
leadership strategies, and encourage young women leaders to take initiative in their lives and communities.
Is there a registration fee for the event?

No, there’s no fee to attend.

We only require students to complete a Personal Statement about themselves and their goals after high school.
This statement must be returned with the registration form.

Once accepted, students will receive a confirmation packet, which will include directions
and parking instructions, to verify that a seat is being held for them.
Should parents stay for the event?

In order for the students to make the most of their forum experience, parents are encouraged to drop off their
student and return to pick them up after the event is over. Enjoy your day off – we’ve got it covered.
Will lunch be provided?

Yes. Please notify us of any dietary restrictions on the permission form.
Is there a dress code?

Your teen should wear school appropriate clothing – and bring a light jacket, as the room may be cold.
What happens if there’s an emergency the day of the event?

We will attempt to contact the parent/guardian first, and then the emergency contact you’ve provided on the
permission form.

Girls are not allowed to leave the event without parent/guardian permission.
Capital One Public