Newman Club (Campus &amp; Young Adult Ministries)

NAME: (first/middle/last) REQUIRED Please fill out this field. Please enter valid data.

CELL PHONE# REQUIRED Please fill out this field. Please enter valid data.

PREFERRED Email REQUIRED Please fill out this field. Please enter an email address.

DOB (birth mo/da/yr) REQUIRED Please fill out this field. Please enter valid data.

LIST ALLERGIES (or "none) REQUIRED Please fill out this field. Please enter valid data.

Level @ BSU Freshman Sophmore Junior Senior Graduate This is my first year @ BSU Not attending college

BSU TECH ID# (or "none") REQUIRED Please fill out this field. Please enter valid data.

DORM Oak Tamarack Birch Cedar Linden Pine University Heights

DORM Room Number -- OR -- LOCAL address REQUIRED Please fill out this field. Please enter valid data.

HOME Information:

EMERGENCY CONTACT NAME: REQUIRED Please fill out this field. Please enter valid data.

EMERGENCY CONTACT PHONE # REQUIRED Please fill out this field. Please enter valid data.

Home Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Ministries you would be willing to help in? REQUIRED Read Music Usher Communion Nothing at this time Please fill out this field.

Transportation? REQUIRED I have a car to use in Bemidji I will need a ride Please fill out this field.

THANK YOU for registering! We look forward to having fun while growing our faith...

St.Philip's Catholic Church