Add Student

Please provide the following information to create a MyMSiC.org Account. Once you submit this form, sign in using the credentials you create.
Items marked with a * are required.

Email address (main correspondence method) *

Student/Attendee First Name *

Student/Attendee Last Name *

Grade Level *

Date of Birth (mm/dd/yyyy) *

Gender *

Ethnicity *

I grant MSiC authorization for Photo/Video/Audio rights for this student/attendee *

Student /Attendee will adhere to MSiC Internet policies *

Student/Attendee Home Address *

City *

State *

Zip Code *

Country *

Primary Phone *

Additional Phone

School District *

School *

List any student/attendee allergies. If none, write 'NA'. *

List any student/attendee activity restrictions or special needs. If none, write 'NA'. *

List any additional individuals authorized to pickup student/attendee along with telephone number. If none, write 'NA'. *

Are you a parent/guardian registering a child under 18 years of age?

Interests

Engineering

Mathematics

Science

Technology

Parent/Guardian Information

ONLY select this box if the student is an adult over the age of 18.

Parent/Guardian Name *

Address *

City *

State *

Zip Code *

Country *

Parent/Guardian Phone *

Parent/Guardian Additional Phone

Parent/Guardian Email