First Name Middle Initial Last Name Gender Female Male Phone Birthdate (mm/dd/yyyy) Parent/Guardian Information Use below information for Emergency Contact Name Phone Parent E-mail Confirm Parent E-Mail Grade in School <select> 7 8 9 10 11 12 College T-Shirt Size <select size> XSmall Small Medium Large XLarge 2XLarge 3XLarge 4XLarge 5XLarge Dietary Restrictions Vegetarian Gluten free Dairy free Other Allergies (Medical/Seasonal/Etc)
Address City State <select state here> Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Outside United States Zip Code Student E-mail address Confirm Student E-mail address Emergency Contact Name Phone E-mail Confirm E-mail Division <select division> Adult Rehabilitation Centers Command College for Officer Training Eastern Michigan Division Heartland Division Indiana Division Kansas and Western Missouri Division Metropolitan Division Midland Division Northern Division Other Territorial Headquarters Western Michigan/Northern Indiana Division Western Division Wisconsin and Upper Michigan Division Corps <select corps> Other