Event Registration

First Name

Middle Name

Last Name

Birth Date

Email Address

Mobile Phone

I agree to receive text messages from Jacksonville State University.

Jacksonville State University utilizes text messaging to send out important notifications and updates about opportunities from Jacksonville State University. Message frequency may vary. Message and data rates may apply. You can text STOP to opt out at any time. Text HELP for assistance. For more information visit our privacy policy.

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

Address

Address (cont)

City

State/Province

Zip Code

Address Line 3 (Province and Postal Code)

Country

Event Preferences and Accessibility

Number of Guests

Enter the number of guests (limit of four) who will be with you. Enter 0 if you will not have any guests with you.

Accommodation Information

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, sign language interpreters, and accessible seating 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. To request accommodations, please share your request in the box below.

Will you need accommodations at this event?

Parent/Supporter Information

First Name

Last Name

Email

Add additional parent/supporter?

Parent/Supporter 2 Information

First Name

Last Name

Email

I want to connect about Spanish-language support or services for my parent or supporter.

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

Academic Program of Interest

Event Registration

Spring Preview Day

Event Preferences and Accessibility

Parent/Supporter Information

Parent/Supporter 2 Information

High School

Future Plans