Parish Registration/Interest

School REQUIRED Michigan Tech Gogebic C.C. Other Please fill out this field.

First Name (Formal) REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Preferred First Name (Nickname) Please enter valid data.

Gender REQUIRED Male Female Please fill out this field.

Year in School REQUIRED Please fill out this field.

Anticipated Graduation Date Please enter valid data.

Dorm and Room Number/School Address Please enter valid data.

Graduate Student Yes No

Cell Phone REQUIRED Please fill out this field. Please enter valid data.

Major Please enter valid data.

MTU Email REQUIRED Please fill out this field. Please enter valid data.

Home Street 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.

Parent Phone(s) Number Please enter valid data.

Parent Email(s) Please enter valid data.

Dad's Name Please enter valid data.

Mom's Name Please enter valid data.

Is Dad a Tech Grad Yes No

Is Mom a Tech Grad Yes No

Select your interests below:

Are you interested in the following Community Activities? Bible Study St. Al's Sports Team (Broomball, IMs, etc.) Liturgical Minister (Usher, Lector, Altar Server, EMHC) I'm Catholic & Want to Learn More I'm Catholic and would like to be Confirmed I'm Not Catholic, but Interested

I'm Currently Involved... As a Varsity Athlete In Greek Life (fraternity/sorority) ROTC

If an Athlete, What Sport? Please enter valid data.

If ROTC, which branch? Please enter valid data.

If Greek Life, which house? Please enter valid data.