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Family Circle Subscription Form
Family or Parent Contact Information
Your Name
*
First Name
Last Name
Your Phone
*
Your Email
*
Verify Email
*
Billing Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Student Contact Information
Student Name
*
First Name
Last Name
Student Phone
*
Student Email (.syr)
*
Verify Email
*
Is your student living on-campus or off-campus for the 2019-2020 academic year?
*
select one
On-campus
Off-campus
Off-campus address
*
Include full address
On-campus address
*
Include dorm and room/apartment number
What size t-shirt or sweatshirt does your student wear?
*
select one
Small
Medium
Large
Extra-Large
Family Circle Subscription Information
What Family Circle level would you like to subscribe to?
*
$360
-
Full Circle
$180
-
Chai Circle
Add 3% to my total amount to help cover the payment processing fees
