Fall Preview Day 2012 Registration

Date Attending *

First Name *

Middle Name or Initial

Last Name *

Preferred First Name *

Street Address *

Street Address 2

City *

State *

Zip Code *

Phone *

E-mail Address *

Gender *

High School

High School Graduation Year

If transferring from another college, please enter the college you attend now

Semester of desired entrance *

Year of desired entrance *

Possible majors

Will you be attending the Equestrian, Bass Fishing, or Clay Target Shooting Programs from 1:00 p.m. - 2:30 p.m.?

Including your self, how many people will be attending this event? *

If other, please specify.

Mississippi College