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Student Registration Form
Student Registration Form
Student Registration Form
Student's Name
(Required)
First
Last
School Name
(Required)
Email for confirmation
(Required)
Phone
Number of guests attending with this student. NOTE: If no guests are attending with this student, leave quantity field below blank and proceed to the "Submit" button.
Price:
$35.00
Quantity:
Please enter up to four guests (i.e. parents, family) per student winner paying $35 per person. DO NOT INCLUDE SCHOOL ADVISER IN THIS SECTION. A separate form is required for all advisers or school officials.
Guest Name 1
First
Last
Guest Name 2
First
Last
Guest Name 3
First
Last
Guest Name 4
First
Last
If you have more than four guests, please complete another online form.
Credit Card
American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number
Expiration Date
Month
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
Year
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
Security Code
Cardholder Name
CAPTCHA
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