Sully Super Saturday Registration Form


Preview Day...The Lobo Way!!! Alpine, Texas February 16, 2008 Registration time – 9:30-10:30

State law requires that you be informed of the following:

(1) you are entitled to request to be informed about the information about yourself collected by use of this form (with a few exceptions as provided by law);
(2) you are entitled to receive and review that information; and
(3) you are entitled to have the information corrected at no charge to you.

School Address	City	State	Zip
Name:	Contact Person for groups:
Address:	City:
State	Zip	Phone:	Email:
School Currently Attending:

High School Graduation Year:
I am a (Please select one from below)
Transfer Student	High School Senior	High School Junior
Graduate Student	Other
If Other, please specify:
Intended Major:
Have you applied to Sul Ross State University?	Yes No	If yes, have you been admitted to Sul Ross State University?	Yes No
Number of Guests attending with you.

Credit Card Approval

I will be paying with Check or Money Order Credit Card

CREDIT CARD AUTHORIZATION:

I authorize Sul Ross State University to charge the specified fee to my credit card account.

Select one:    Visa      Master Card
Card holder's name:
Last:  First:  MI:
Card Holder's SSN:
Name as seen on credit card:
Your credit card number will only be seen by the staff responsible for processing this form. We will not store your card number and information. This page is a secure web page and is using encryption algorithms to protect the transmission of sensitive information.
Card Number:      Exp. Date:
Mailing Address:  City:
State:  Zip:

NOTE: If paying by check or money order, make it payable to Sul Ross State University and
Mail to:
Office of Recruiting
Sully Super Saturday
SRSU BOX C-2
Sul Ross State University
Alpine, Tx 79832

Non-Discrimination Statement:
No person shall be excluded from participation in, denied the benefits of or be subject to discrimination under any program or activity sponsored or conducted by Sul Ross State University, on any basis prohibited by applicable law, including, but not limited to, race, color, national origin, religion, sex, age or disability.