GenCyber Boot Camp Registration Form 2017

First Name*

MI

Last Name*

Home Street Address*

Address 2

City*

State

Postal / ZIP Code*

Student's Email*

Student's Phone Number*

Graduation Date*

Parent / Legal Guardian's Name*

Parent / Legal Guardian's Phone*

Parent / Legal Guardian's Email*

Explain why you desire to participate in the GenCyber Camp.*

What programs / activities are you involved in inside and outside of school?*

High School / Middle School Attending*

The Middle School Session is now full. If you would like to be placed on our waiting list for the Middle School session (June 12-16), then please send an e-mail with your child’s name and e-mail address to: um-GenCyber@memphis.edu.

Registration type*

High School only

Have you attended the GenCyber Camp in prior years (2016)?

Yes

No

Text Messages (Optional)

I agree to receive text message communications from the University of Memphis