Registration Form - Engineering and Computer Science Preview Day 2016

Note: Red * text indicates required fields

Personal Information

First Name, Last Name *
Address Line 1 *
Address Line 2
City, State, Postal Code *
Phone Number *
Email Address *
Gender   
  
Major Interested in
Birthdate *

High School and Church Information

High School Name *
High School City *
High School State *
Graduation Year *
Church Name *
Church City *
Church State *

Housing Information

If you are coming Friday, please plan to arrive between 5-7:30 p.m.
Time of Arrival (if on Friday)


Student Housing

Event Details

Total people attending (please include any parents or siblings who plan to attend) *

Payment Information

Total Amount: $