Registration



Name
Title
First Name

Last Name
Spouse Information
Spouse Name

Title

First Name

Last Name
Gender

DOB
(mm/dd/yyyy)
T-Shirt Size
Position



Requested Roommate
Dietary Restrictions






Other

Email


If you are attending Regeneration, please click the checkbox so that we can use the information to assign housing for both events at once. PLEASE NOTE: Clicking this checkbox does NOT register you for Regeneration. It only helps us with assigning housing. You MUST go to the Regeneration website to register separately for that conference.

Position







Address
City
State
Zip
Phone
E-mail
Gender

Date of Birth
(mm/dd/yyyy)
T-Shirt Size
Requested
Roommate
Dietary Restrictions






Other:


Division
Corps

Emergency
contact
Name:
Phone:

Electives

Please select your Challenge Activity. Activity space will be available on a first come, first serve basis (only activities that are still open are listed)
Please select your Discover Activity. Activity space will be available on a first come, first serve basis (only activities that are still open are listed)
Challenge Activity DescriptionsDiscover Activity Descriptions

Registration Fee


Registration Fee:$0
Discount:-$0
Registration Total:$0