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Registration Form

Presenters and Volunteers should use this registration form instead.

* = required field

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Personal Information

Title

First Name*

Last Name*

Street Address*

City*

State*

Zip/Postal Code*

Email Address*

Phone Number*

Professional Information

Position Title

Institutional Affiliation

Profession

I am a prospective college student.

	Yes
	No

Registration Information

Payment Amount*

	$50 - General Public
	$25 - Luther Faculty, Staff, and Alumni
	$10 - Luther Student (Scholarships available upon request; write to [email protected])
	$10 - Non-Luther Student

Payment Information

Name as it appears on card*

Billing Street Address*

City*

State/Province*

Zip/Postal Code*

Country*

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