Alabama Civil Rights Trip Registration Form
Please fill out this form in order to register for CBI's 11th and 12th Grade Civil Rights trip to Alabama.
First Name *
Last Name *
Date of Birth *
MM
/
DD
/
YYYY
Home Address *
City *
State *
Zip *
Student's Email
Home Phone *
Student Cell Phone *
Dietary Needs *
(Vegetarian, Vegan, Gluten Free, Food allergies, etc.)
Parent 1 First Name *
Parent 1 Last Name *
Parent 1 Email *
Parent 2 First Name *
Parent 2 Last Name
Parent 2 Email
2 Student Roommate Request
Choose 2 fellow participants that you would like to share a room with on the trip
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service