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Alternative Spring Break Registration
Attendee Information
Name:
*
First Name
Last Name
Affiliation:
*
select one
Alumni
Friend
Graduate Student
Local Resident
Parent
Parent of Alumni
Undergraduate
Class Year:
Example: 2019
Email:
*
Verify Email
*
Mobile Phone:
Emergency Contact Information
Parent/Guardian Name:
*
First Name
Last Name
Parent/Guardian Email:
*
Verify Email
*
Parent/Guardian Mobile Phone:
Payment/Miscellaneous Information
Please choose one of the following options regarding payment:
*
The total cost of the trip is $150. An initial $50 deposit is required by February 9, 2020. A second deposit of $50 is required by March 1, 2020. Please pay the remaining $50 by March 8, 2020. Email Sr. Leandra (lkosmoski@ur.rochester.edu) if you have any questions or require a scholarship.
I will pay in cash/check/credit card.
I will pay via Venmo (@URNewman).
I will need a scholarship.