DWU - Visit Day Registration

I will attend the following Visit Day:

Friday, March 26, 2010 (Junior Visit Day)
Please call me to schedule an individual visit

First Name:

Last Name:

Address:

City:

State:

Zip:

Phone/Cell:

- -

E-mail address:

High School:

Grad year:

Academic Interests:

Extra-curricular Interests:

Will your parents come with you?

Yes
No

If so, their names:


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