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* = Required Field
To register for the
My Diploma. My Life.
event on October 18, 2013 from 11:00am-1:00pm at LCC's Dart Auditorium, please complete the form below.
or contact us at 517-483-9707 with any questions or for additional information.
* First Name
* Last Name
* Home Address (No PO Boxes)
* Zip Code
* Date of Birth
* Are You Currently Enrolled in School?
* If Yes, what school do you attend?
* If No, what is the last school you attended?
* How did you hear about this event?
Flyer or poster
Word of mouth
* Number of Guests Attending with You