Event Registration

First Name

Last Name

Email Address

Phone

Military Affiliation

Number Of Guests

Check if address is outside of U.S. or Canada

Street Address

Apt/Suite

City

State/Province

Zip/Postal Code

Address Line 3 (Province and Zip/Postal Code)

Country

On Campus or Online?

What type of degree are you interested in pursuing?

Program of Interest

Desired Start Term

How did you hear about Regent?

Depending on what you chose, can you tell us more? (i.e. What search engine? Who referred you?)

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