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Jesse Helms Center > Program Registration
Program: Session I: June 20-24, 2010
Registration Deadline: 6/20/2010
Program Date(s): 6/20/2010
Location: Wingate University
Cost: $75.00

All fields denoted in red are required.
First Name: 
Middle Name: 
Last Name: 
Preferred Name (ex. Bill instead of William): 
Mailing Address: 
City: 
State: 
Zip: 
Email Address: 
Contact Phone Number: 
DOB (Ex. 10/01/1975): 
Gender: 
Parent/Guardian(s): 
Parent/Guardian Phone Number: 
Have you ever attended FELC before?: 
Name of School: 
Grade you will enter in fall 2010: 
Current Age: 
G.P.A.: 
Hobbies/Interests/School Activities: 
How did you learn about this program?: 
Reference/Nominator/School Official: 
Reference/Nominator/School Official Email: 
Reference/Nominator/School Official Contact Number: 
Reference/Nominator/School Official Title: 
References should not be family members:  : My reference is not a family member
Why do you want to attend? (at least 150 words): 
Please confirm the following:  : I, the student applicant, wrote my own personal statement
 : I, the student applicant, was honest and truthful in my entire application
 
  Enter the verfication code as it is shown above.
 
 

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