Student Registration

Title

First Name

Last Name

Email

Non TAMU

Phone

(###)

###

####

Permanent Address

City

State

Zip

Gender

Male

Female

Birthday

MM

DD

YYYY

University

Class Year

Relationship to St. Mary's

Student

Graduate Student

Title

Father's First Name

Father's Last Name

Title

Mother's First Name

Mother's Last Name

Parent Email

Parent Phone

(###)

###

####

Are you interested in OCIA/becoming Catholic?

Yes

No

Do you want to be contacted about getting plugged in?

Yes

No