Register for the Duke Youth Academy Reunion 2008

First Name (Required)

Last Name (Required)

Preferred Name (Required)

(for nametag)

Gender (Required)

Male Female

Denomination/Congregation

School (Required)

Graduation Year (Required)

Major (Required)

Mailing Address1 (Required)

Mailing Address 2

City (Required)

State (Required)

Zip (Required)

Phone (Required)

Email Address (Required)

Verify Email Address (Required)

What year did you attend DYA? (Required)

Role (Required)

Student Staff

Do you plan to travel by car or plane? (Required)

Car Plane

Please list any special needs we can accommodate:

(dietary, accessibility, etc.)

Early-bird registration ($100) is due by November 5, 2007
Regular registration ($115) is due by December 3, 2007