Lewisburg Area High School PSAT Registration
This form is for students registering for PSAT exams (which includes either the 11th grade PSAT NMSQT administered in the Fall or the 10th grade PSAT 10 administered in the Spring).
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Email Address
example@example.com
Student Name(s)
Rows
First Name
Last Name
Grade
Student
9
10
11
12
Select your Corresponding Fee:
*
prev
next
( X )
PSAT Registration Fee
$18.00
$
18.00
Quantity
1
2
Lunch Status
Paid
Free/Reduced
Item subtotal:
$0.00
$
0.00
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
Signature
*
Submit
Should be Empty: