* 1. Student first name:

* 2. Student last name:

* 3. Street address:

* 4. City:

* 5. State:

* 6. Zip code:

* 7. Phone number (with area code):

* 8. Gender:

* 9. Student email address:

* 10. School:

* 11. Classification (as of Fall 2014):

* 12. What is your future major/area of interest?

* 13. Parent(s)/Guardian(s) names:

* 14. Parent(s)/Guardian(s) work phone:

* 15. Will your parent(s) or guardian(s) attend the conference with you?

* 16. Do you plan on requesting overnight lodging at Murray State University? (If yes, please complete the Housing Form listed on the main conference page.)

* 17. If the student or parent(s)/guardian(s) need special accommodations (I.e. handicapped accessible rooms or vegetarian meals) during the conference, please specify below.

* 18. Will the student or the parent(s)/guardian(s) need transportation to the conference? (Transportation will be arranged on a limited basis.)

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