AICUO Independent College Day Registration Form

Note: Required fields are marked with a red dot.

* = required field

Name *

First

Last

College / University Name *

College / University Mailing Address *

Phone Number *

###

####

Email Address *

Permanent / Home Address *

Street Address

Street Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

Major(s) *

Year *

First-Year

Sophomore

Junior

Senior

Graduate

(optional) I am a recipient of the Ohio College Opportunity Grant

Yes

Campus Contact Individual *

Would you like a vegetarian lunch? *

Yes

Spam Prevention *

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