Date you plan to attend:

*Name:

Address 1:

Address 2:

City:

State:

Zip:

Phone:

*Email:

High School:

Church:

*ACT/SAT score (if you have not taken either test, enter 0):

*GPA:

*Month and Year of High School Graduation:

*Current College or University you are attending:

*Intended Major:

Other areas of interest:

T-shirt Size:

Will your parents be attending with you? (Not required, but certainly encouraged!)

Yes No

* - Required fields