Events Registration Form: Adelphi University

Events Registration Form

Please complete the form below. Note that only the first/last name, address, and home phone fields are required, but the more information you provide, the easier it will be for us to contact and assist you.


You are registering for the following event: Tuesday, August 11, 6:00 PM - 8:00 PM - Open House If you wish to sign up for a different event, please return to the admissions events page to select a different event.


Name
	Mr. Ms. Mrs. Miss
First Name:
Middle Initial:
Last Name:
Gender:	M F

Home Address
Street Address Line 1:
Street Address Line 2:
City:
State:
Zip / Postal Code:
Home Email Address:

Phone
Home Phone:	(ex: 516-877-3470)
Work Phone:
Cell Phone:

School Information
Current or Most Recent High School or College Attended:

Anticipated Entry Term
	Fall 2009
	Spring 2009
	Fall 2010
	Other:

I will be a
	Freshman
	Transfer
	Graduate
	Adult Academic Programs in University College Bachelor's Degree - Freshman
	Adult Academic Programs in University College Bachelor's Degree - Transfer

Academic area of interest


Have you applied to Adelphi?
	Yes
	No

How many guests will be accompanying you?
	(maximum of 2 guests please)

What prompted you to visit Adelphi's Events Web site?

Your information may take a few seconds to process.
Please do not click the submit button more than once.

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