ST. HERMAN CONFERENCE REGISTRATION FORM

Please complete this form completely. An entry must be provided for each field. You will be redirected to further information and a download page.


Last Name First Name

Address City State ZIP Code

Cell Phone Home Phone Email Address

Age Date of Birth Gender female male

Parent's Name (or emergency contact) Parent's (or emergency) Phone

Parish Parish Priest

Your first choice of three roomates

Your chioces will be honored as far as possible, but we can not guarantee your choices.

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