Harrisburg University January Open House

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Event Registration

*First Name

*Last Name

*Birthdate

*Email Address

*Mobile Phone Number

*May we text you?

Yes

No

*Mailing Address

Country

Street

City

Region

Postal Code

Additional Information

*Select the option below that best describes you:

*Please select the program below that most interests you:

*What year do you plan on enrolling?

*What semester are you interested in?

Current or Most Recent School

*Anticipated (or Actual) Graduation Date:

Number of guests attending with you (do not include yourself)

Lunch will be served during the open house. Do you or any of your guests have any of the following dietary restrictions?

How many people in your party are Vegetarian?

How many people in your party are Vegan?

How many people in your party have a food allergy?

Please list the full name of Guest #1 and the corresponding food allergy:

Please list the full name of Guest #2 and the corresponding food allergy:

Please list the full name of Guest #3 and the corresponding food allergy:

Please list the full name of Guest #4 and the corresponding food allergy:

Please list the full name of Guest #5 and the corresponding food allergy:

Please explain: