First name: Last name:
Email:
Email of paypal account I will be paying with:
Phone:
Address line 1:
Address line 2:
City: State: ZIP code:
Room type: Dorm Style - $105 Day pass - $60
Please write the name of the person you would like to share a room with, if applicable:
Do you want the boxed dinner for Friday night?
Please detail any special dietary requests that you have:
Do you have any other special needs we should be aware of?
Are you requesting a partial scholarship?
If you would like to make a tax-deductible donation to our scholarship fund, please indicate the amount of your donation here:
