JSHS National Symposium

JSHS Director Registration

JSHS regional directors, or their designated representative, must pre-register:

1) five (5) student delegates; and 2) one (1) adult leader/chaperone who will attend National.

Pre-registration should immediately follow the completion of the regional symposium or no later than two weeks following the symposium. Following pre-registration, direct attending students and and adult leader / chaperone to the JSHS website to complete the registration process.

Note: An AUTHORIZATION CODE will be issued upon completing pre-registration. GROUP records may be accessed at any time with this code. INDIVIDUALS access registration with SSN.

This pre-registration form has been completed by:

Date of pre-registration and request for airline tickets: 2009-01-06 20:43:22
Regional director first name: Last name:
Your Social Security Number:
Your email address:
Choose your regional symposium:

Adult leader/chaperone

Legal first name: Legal last name:
Email address:
Social Security Number:
Closest major airport is in what city?

Arrival (ie. arrival to symposium):
Date:
(in the form of yyyy-mm-dd)

Note any time restrictions or special requests:

Departure (ie. arrival from symposium):
Date:
(in the form of yyyy-mm-dd)

Note any time restrictions or special requests:

Student delegates

Student #1

Legal first name: Legal last name:
Social Security Number (in the form of xxx-xx-xxxx):
Student Participation:
Email address:
Regional scholarship award:
Closest major airport is in what city?

Arrival (ie. arrival to symposium):
Date:
(in the form of yyyy-mm-dd)

Note any time restrictions or special requests:

Departure (ie. arrival from symposium):
Date:
(in the form of yyyy-mm-dd)

Note any time restrictions or special requests:

Student #2

Legal first name: Legal last name:
Social Security Number (in the form of xxx-xx-xxxx):
Student Participation:
Email address:
Regional scholarship award:
Closest major airport is in what city?

Arrival (ie. arrival to symposium):
Date:
(in the form of yyyy-mm-dd)

Note any time restrictions or special requests:

Departure (ie. arrival from symposium):
Date:
(in the form of yyyy-mm-dd)

Note any time restrictions or special requests:

Student #3

Legal first name: Legal last name:
Social Security Number (in the form of xxx-xx-xxxx):
Student Participation:
Email address:
Regional scholarship award:
Closest major airport is in what city?

Arrival (ie. arrival to symposium):
Date:
(in the form of yyyy-mm-dd)

Note any time restrictions or special requests:

Departure (ie. arrival from symposium):
Date:
(in the form of yyyy-mm-dd)

Note any time restrictions or special requests:

Student #4

Legal first name: Legal last name:
Social Security Number (in the form of xxx-xx-xxxx):
Student Participation:
Email address:
Regional scholarship award:
Closest major airport is in what city?

Arrival (ie. arrival to symposium):
Date:
(in the form of yyyy-mm-dd)

Note any time restrictions or special requests:

Departure (ie. arrival from symposium):
Date:
(in the form of yyyy-mm-dd)

Note any time restrictions or special requests:

Student #5

Legal first name: Legal last name:
Social Security Number (in the form of xxx-xx-xxxx):
Student Participation:
Email address:
Regional scholarship award:
Closest major airport is in what city?

Arrival (ie. arrival to symposium):
Date:
(in the form of yyyy-mm-dd)

Note any time restrictions or special requests:

Departure (ie. arrival from symposium):
Date:
(in the form of yyyy-mm-dd)

Note any time restrictions or special requests:

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