Residential Life Collegium

Delegate Registration Form, KARH 2013

School:

Name:

Email:

Gender:

T-Shirt size: XS S M L XL XXL

Dietary Needs:

Allergies:

Special accommodations needed

Are you asthmatic/allergic to smoke?

*Are you okay sleeping 3 people to one king-size bed?

Emergency Contact Information

Name:

Relation:

Phone Number:

Insurance Provider Name:

Insurance Policy Number:

Insurance Provider Phone Number:

*To take advantage of as many rooms at the hotel as possible, individuals who answer yes to this question may be placed in a room with one king-size bed. Individuals who answer no to this question will be placed in a room with two double beds, with two people in each bed.

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