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Registration Form

Fields marked with a * are required.

First Name

Last Name

Primary Email

Primary phone number

Username

Are you an American or International?

Password

Retype Password

Passwords should be atleast 10 characters. They may contain letters, numbers, and symbols.

Gender

Date of Birth (mm/dd/yyyy)

When will you leave Manhattan?

Street address

City

State

Zip code

I am married

What is your spouse's name?

I have children

What are your children's names and ages?

Student status

Major field of study (at K-State)

What is your occupation?

What are your interests?

I give my permission for photos of me to be used publicly by HIS.

I would like to be on the HIS mailing lists.