Messiah College: Department of Engineering

Engineers' Weekend - Online Registration
November 9 - 10, 2012 or February 22 - 23, 2013

Instructions

Please complete and submit the registration form below. (Alternatively, you may download, complete, and mail in a paper copy of this form.)
The $20 registration fee is due when you arrive on campus, or you may prepay by mail. Please make check payable to Messiah College and send to the following address:

Jean McCauslin
Department of Engineering
Messiah College

Box 3034
Grantham, PA 17027
Registration must be received by October 26, 2012 for the November 9-10, 2012 weekend and February 8, 2012 for the February 22-23, 2013 weekend.

Registration Form

Preferred Attendance Date

Please select the date you would prefer to attend:

Are you available to attend the other date?

Registration Information

NAME: (First) (Last)

PREFERRED NAME (for name tag):

(Select One)

Number of family members (including participant) attending the Design Play-Offs:

(Saturday, 2:00-4:00 PM)

HIGH SCHOOL LEVEL: (Select One)

ADDRESS 1:

ADDRESS 2:

CITY: STATE: ZIP CODE:

PHONE: Home Cell (optional)

EMAIL ADDRESS:

(A valid email address is necessary so that we can confirm your registration)

Do you have any dietrary restrictions or other special requirements?

If so, please explain in the comments section below

Comments, Questions, or Requests: