Junior Eagle Day Registration

To reserve your place at Junior Eagle Day, fill out the registration form below. Note that all fields marked with an asterisk (*) are required.

Your Name
* Firstname:
Middlename:
* Lastname:
Name Suffix:
Contact Information

* Please provide at least one way for us to get in touch with you:

Email:
Home Phone:  -  - 
Cell Phone:  -  - 
Address:
City:
State:
Zip Code:
Registration Information
* When do you plan to enroll in college?
Current School Name:
Current School City and State:  
When did/will you graduate from high school?
How many people will come with you to Junior Eagle Day?
Your Interests

What are your academic interests?

What extracurricular or sports activities are you involved in?