Event Registration

Preferred First Name

First Name

Middle Name

Last Name

Birth Date

Email Address

Mobile Phone

Text me important updates and reminders

Check if address is outside of U.S. or Canada

Address

Address (cont)

City

State/Province

Postal Code

Address Line 3 (Province and Postal Code)

Country

Registration Details and Accessibility

Number of Guests Attending with You?

Enter the total number of guests attending with you (maximum of 2). If you are attending alone, enter 0

Tour Interests

What do you most want to see or gain from your tour experience? Are there any specific organizations you're interested in joining in college? (Optional)

Jacksonville State University is committed to providing reasonable accommodations for all programs, events, and services. Accommodations such as accessible seating, alternative formats for presentation materials, and sign language interpreters are available upon request. Requests for American Sign Language Interpreting and/or CART services should be made at least two weeks in advance, when possible. Every effort will be made to implement reasonable accommodations in an effective and timely manner.

Will you require any reasonable accommodations?

Parent/Supporter Information

Is Spanish the primary language spoken in your home?

Firstname

Lastname

Email

Add additional parent/guardian?

Parent/Supporter 2 Information

Firstname

Lastname

Email

High School

Organization Name (full or partial) Enter at least 3 characters to search by school name. Country

Future Plans

I Have

Anticipated Entry Term