EMERGE Registration Form NOTE: This form will only work on Chrome or Safari browers. Student Name Gender ---FM Birth Date (mm/dd/yyyy): Home Address City State Zip Home Phone # Cell Phone # Your Email (required) College College Mailing Address City State Zip Campus Housing? ---YN Graduating (mm/dd/yyyy): Dorm Phone # Major # of Sessions per year 2345 Special Dietary Needs Approx. final test dates for the school year(Fall-mm/dd/yy, Spring-mm/dd/yy) To minimize spam please enter the characters below (NOT case-sensitive) in the space provided. Thank You!
