2017 Legislative Day Registration Form

* Indicates required field

Name *

First

Last

Student or Adult *

School Name If Applicable *

BSU Title/Position If Applicable *

Email *

Cell Phone Number *

Name of Chaperone If Applicable *

My Emergency Contact Person/Guardian *

Phone Number *

Did you RSVP via email at [email protected]? *

Yes No

I understand that I must be at the departure location no later than 11:45p.m. on March 29th or the bus may leave without me. I also, understand that my ride must be at pick up location no later than 15 minutes after arrival on March 31st. *

YES NO

CCBC Member? *

YES NO

I am *

Male Female

Shirt Size *

Submit