KSEA 2023 NMSC Registration - Nebraska Chapter

KSEA 2023 NMSC Registration

Nebraska Chapter
Student Name*

First NameLast Name
Student Birth Date*

MonthDayYear
School Name*
School Level*

4th grade5th grade6th grade7th grade8th grade9th grade10th grade11th grade
Student Email (You may use your Parent's email address. You can use only one email address per student.)*
example@example.com
Please choose Chapter*

Credit Card Details (If your total is $0.00, please do not enter the credit card information)
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

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