Freshman Expedition Online Registration

First name *

Last name *

Gender *

Male
Female

Address *

City *

State *

Zip *

Daytime phone

Evening phone

E-mail *

Birthdate

T-shirt size

Emergency Information

Parent or legal guardian *

Emergency contact's phone number

Health Insurance Company

Policy number

Allergies

Dietary needs

Known medical conditions

I claim that the information provided in this registration is correct and accurate, and I understand the loss of deposit if I cancel. Please sign this form by typing your name, having your parent type their name, and typing the date in the spaces provided below. Your signature validates this application and indicates that you have completed the information and that the information is true.

Student's signature *

Parent's signature *

Upon hitting the submit button, you will be directed to a payment center page to complete your registration. This page allows you to pay your registration fee through PayPal. Please have your credit card ready. Remember, registration is not complete until payment is received.