Email address *
First Name *
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Last Name *
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Computing ID *
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Cell Phone *
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What year are you? *
Please identify your race/ethnicity category. (Check all that apply) *
Are you a student athlete? *
Please select your TOP program choice: (for information about each site, visit http://www.madisonhouse.org/program-sites-halo/) NOTE: These are the only sites currently open for Spring Registration. *
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