Event Registration

Student First Name

Student Last Name

Student Preferred Name

Cell Phone

Home Phone

Date of Birth

Please Send a Text ReminderYesNo

Email Address

Confirm Email Address

Address Line1

Address Line2

City

State/Province

Postal Code

T-Shirt Size

Academic Information

Year of Graduation

Plan to Enroll

Student Type

Academic Program of Interest

Current High School or College\University

ACT Score

Including yourself, how many guests will be attending?

Attending with a Friend - Friend's name

Term You Plan to Enter

Student Type

Location

Academic Program