EmailMe Form - Accepted Student Day 2016 Registration

Number of people attending with the student: *

Please do not include the student in this count.

Student's Name *

First Last

ID Number

Student's Date of Birth *

MM / DD / YYYY

Email *

Mailing Address *

Street Address City State / Province / Region Postal / Zip Code

Phone *

### - ### - ####

Intended Major: *

T-shirt Size *

If you or a family member require special accommodations for the daily events and activities, please provide detailed information here.

i.e., physical, dietary, etc.
Please note: LHU does not have wheel chairs or other medical equipment available.

A confirmation message will be sent to the email address provided. Please verify that you have typed your email address correctly.