Student Name: *

School: *

Grade: *

Undergraduate
Graduate

Expected graduation date: *

Age on Aug. 6, 2010: *

Street, City, State: *

Email Address: *

Telephone Number: *

Emergency contact name: *

Emergency contact phone: *

Professor/Advisor name: *

Professor/Advisor email: *

Attend Presidents Meeting? (1:00 to 5:00 pm Friday): *

Yes No

Attend Friday Hospitality Suite? (5:30 to 9:00 pm): *

Yes No

Attend Saturday Educational Events?: *

Yes No

Attend Saturday Lunch?
(12:00 to 1:00 pm): *

Yes No

Attend Sat. Night Event? T.B.D.: *

Yes No

If attending Sat. Night Event - number in your party: *

Comments: