DMI Summer Camp Registration

DMI Summer Camp

July 7-12, 2024
Your Name:*

First NameLast Name
Birth Date:*

MonthDayYear
Gender*
Parent/Guardian's Name:*

First NameLast Name
Primary Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone:*

Area CodePhone Number
Mobile Phone:

Area CodePhone Number
Email Address:*
example@example.com
Desired Name Tag:*
Camp Shirt Size:*

SmallMediumLargeExtra-largeXXL
How did you hear about Camp?:*
Choose Your Career Track
Career Track*
Music Interests
Favorite Genre(s) of Music

School Information
High School Name*
High School Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Year in School:*
Emergency Contact Information
Emergency Contact Name:*

First NameLast Name
Relationship to Student:*
Emergency Contact Phone Number:*

Area CodePhone Number

Complete DMI Summer Camp Cost: $600

(Includes curriculum, materials, field trip, lodging, and all meals)

Check or money orders payable to Delta State University

(add DMI Summer Camp to the memo section)

Please send the refundable $100 application (applies toward tuition) fee to:

DMI Summer Camp

DSU Box 3114

1003 W. Sunflower Road.

Cleveland, MS 38733

Deadline for application submission is June 7, 2023
Should be Empty: