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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 6-20 characters, no spaces. 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.