First Name: *

Last Name: *

Address:  *

City:  *           State:   *          Zip:  *

Date of Birth:  *

Contact Phone Number (only used to follow up with you regarding your appointment):  *

E-mail Address (so we can confirm your registration):  *

Planned Major:  *

How did you learn about this event?: *

What time do you plan to arrive on campus? (between 10:00 am & 5:30 pm):  *

What do you hope to accomplish at our event (check all that apply): *