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Registration

Registration

Parent First Name *
Parent Last Name *
Mobile Phone * - -
E-mail Address *
Address *
City *
State *
Zip *
Student First Name *
Student Last Name *
Age *
Gender * Male Female
Grade in Fall 2013 * 9th 10th 11th 12th
Which program are you registering for? *

Music
Journalism
Student T-shirt Size * S M L XL XXL
Does the student have any medical conditions or dietary restrictions we should be aware of? *

Yes No
If yes, please explain:
Emergency Contact First Name *
Emergency Contact Last Name *
Emergency Contact Phone * - -
Is the student a child of a CBU alumnus, employee, sibling of a current CBU student or child of a U.S military veteran? *

Yes No
I have read and agree with Discovery U's terms and conditions.