First Name*

Last Name*

Email Address (Personal)*

Phone Number

High School*

Please select where you are taking your technical coursework:

Intended Major at LCCC:*

If you selected other, please type your major below.

Other major:

How did you find out about this event?

I would like to pick up my swag bag:*

If you chose "mail to me" please enter your address below:

Address 1

Address 2

City

State or Province

Zip Code