COMPLETE THIS ONLINE FORM AND PAY BY CREDIT CARD. PLEASE COMPLETE ONE FORM FOR EACH STUDENT ATTENDING. First Name: Middle Initial: Last Name: Preferred First Name: Address: City: State: Zip: Home Telephone: Work/Cell Telephone: E-mail: Major/Pre-professional Program: Select Birthdate: Birth Month 01 02 03 04 05 06 07 08 09 10 11 12 Birth Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Birth Year 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 Before 1960 Orientation Sessions are filled on a first-come, first-served basis. Please choose a date. Orientation Date Preference: Available Dates June 15, 2012 June 22, 2012 July 13, 2012 July 20, 2012 Number of attendees (include guests): FRESHMAN Student Registration Fee $60 How many? 0 1 Freshman Guest(s) Registration Fee $25 per person How many? 0 1 2 3 Transfer Student Registration Fee $35 How many? 0 1 Transfer Guest(s) Registration Fee $20 per person How many? 0 1 2 3 List the names of guests attending Orientation as you would like them to appear on their name tags. Check beside name if an alum. Click only if an alum:    Guest #1: Click only if an alum:    Guest #2: Click only if an alum:    Guest #3: Comments or Special Needs: If you or a guest is disabled or have special needs, please tell us how we can help you during your Orientation session.