St. Nektarios Campus Ministry Registration
Staying Connected Information & Registration Form
Student Name
Your answer
Name of College or University Attending
Your answer
Year
Freshman
Sophomore
Junior
Senior
Graduate Student
Row 1
Student Email Address
Your answer
Student Cell Phone Number
Your answer
Student College/University Mailing Address
Your answer
Parents' Names
Your answer
Parents' Email Address
Your answer
Home Mailing Address
Your answer
Student's Date of Birth
Your answer
Student's Name Day
Your answer
Check those that apply:
Required
Student's Hobbies/Interests
Your answer
Favorite Color
Your answer
Favorite Sport
Your answer
Favorite Team
Your answer
Favorite Snacks
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Favorite Candy
Your answer
Favorite Author or Book
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Favorite Magazine
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Favorite Music
Your answer
Please list any food allergies...
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