* indicates a required field

First Name *

Last Name *

Age *

Gender *

Graduation Year *

Are you a citizen of the United States? *

School *

Current Address *

City *

State/Province *

Current International Student Province *

ZIP/Postal Code *

Country *

Primary Phone Number *

E-Mail *

Emergency Contact Name *

Please provide emergency contact information about whom to notify in case of an emergency. We only request something valid for April 2015.

Emergency Contact Phone Number *

School POC during Conference *

Please list the Name, address, email and phone number of your schools POC for MCLC 2015.

Special Requirements *

Please note any special physical and/or dietary requirements and/or religious considerations.

Extracurricular Involvement *

Local/school issue of emphasis. *

Conference Topics Choice #1 *

This year's conference will focus on four topic areas. You will be involved in each of these topic areas, but will have the
opportunity to focus in one. Please rank order your topic preferences.

Conference Topics Choice #2 *

Conference Topics Choice #3 *

Conference Topics Choice #4 *

Mode of Transportation *


Transportation Information *

Please provide your:
Airline information and flight number.
Amtrack Information and itinerary.

Local City Departing Location *

Local City Departure Date & Time *


Arrival Date & Time to West Point *


Arrival Location *

Departure from West Point Date & Time *


Departure Location *


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