Cyber Competition Registration
WIU School of Computer Sciences
Your Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Gender Identity
Please Select
Male
Female
Transgender Man
Transgender Woman
Non-binary
Agender
Genderqueer
Not Listed
Does Not Apply
T-Shirt Size
*
Small
Medium
Large
X-Large
XX-large
Other
What is your prior knowledge of cybersecurity?
Emergency Contact Information
Emergency Contact Name
*
First Name
Last Name
Relationship to Emergency Contact
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
School Information
School Type
*
Please Select
High School
Community College
University
School City
*
School State
*
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Major
Team Information
Do you have a team yet? Note: A team must have at least 2 students. You are encouraged to have up to 3 students in the team.
*
Yes
No
Do you want us to pair you up with another team member who has not formed a team yet?
Yes
No
What would you like your team to be called? Choose an appropriate name for your team, and then enter it here:
Team Member 1 Full Name
*
First Name
Last Name
Team Member 2 Full Name
*
First Name
Last Name
Team Member 3 Full Name
First Name
Last Name
Team Member 4 Full Name
First Name
Last Name
Note:
Make sure all team members use the same team name when registering for the competition.
Release Consent
Do we have your permission to take pictures and record video during the competition and award ceremony?
*
Yes
No
Do we have your permission to post the pictures and videos taken during the competition on the WIU website and social media?
*
Yes
No
Yes, only post on WIU website
Yes, only post on social media
Submit
Should be Empty: