Laker Gold Scholarship Competition Registration

Your Information

First Name (required):

Last Name (required):

Birthdate (required):
(mm/dd/yyyy - required for identification purposes)

Address (required):

City (required):

State/Prov. (required):

ZIP/Postal (required):

E-Mail Address (required):
Confirmation will be sent to this address

Phone Number required):

Academic Major/Area of Interest (required):

Including you, total number of people attending (required):

Are you sending additional test scores? (required): Yes No

Select hoodie size: (required):

S M L XL XXL

Questions and Comments:


Anti-Spam (required):