Corban Experience Registration

I am registering for:

The Corban Experience II - February 10-11, 2008 - Registration Closed (Sun/Mon)

Please provide the following information:
(*denotes required field)

First Name *
Last Name *
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Home Phone *
E-mail *
Gender Male Female

What year will you or did you graduate from High School?        *

High School
City
State/Province

Please indicate your intended field of Major study:

 

Business Administration
Computer Science
Education
English
Health Sciences
Human Performance
Information Systems Management
Interdisciplinary Studies
Mathematics
Ministry
Music
Psychology
Social Science
Other

What Church do you attend on a regular basis?

Church
City
State/Province
Senior Pastor
Youth Pastor

Other Information:

 

I am coming by myself
I am coming with a group

I would like to room with:

 

a Corban Student I know
Student's Name: 

a person I'm coming with
Person's Name:

Payment required upon online registration:

  • $35.00  (payment information to follow)

The Corban Experience is geared towards students however, we do have a Monday schedule for visiting parents.

Do your parents wish to attend? Yes No

Parent name(s):

Lunch passes needed:

Medical Release 

To be authorized by a Parent or Guardian if visitor is a minor,
or by the visitor if over 18 years of age.

By checking here, you hereby give consent for this person named above to be given medical treatment as may be necessary by a physician in the event of injury, illness, or accident. By checking here you also agree that Corban College will not be held responsible for any financial obligations incurred relating to any medical treatment. You also understand that an immediate attempt shall be made to contact persons at the visitor's home or residence in the event that medical treatment is needed.