Delegate Information
Delegate information
Full Name
*
First Name
Last Name
Gender
*
Please Select
Male
Female
Prefer not to say
Pronouns
*
Please Select
She/her
He/him
They/ them
Grade
*
Please Select
6th
7th
8th
School
*
Please Select
Saint Charles Borromeo Middle School
Harbor Ridge Middle School
Kopachuck Middle School
Saint Patricks Middle School
St. Vincent De. Paul
Lighthouse Christian School
Other
Please specify if you choose “other”
How many conferences have you attended?
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Would like to buy lunch for $5 a day?
*
Please Select
Yes
No
Please list any allergies
*
Attend day 1
*
Please Select
Yes
No
Attend day 2
*
Please Select
Yes
No
How did you hear about BELLARMUN
*
Committee Selection
Here is a page that shows every committee and a list of position in each committee: https://www.bellarmun.com/committees-1
First Committee Choice
*
Please Select
SOCHUM
HCC
UNEP
CELAC
First Choice Position
*
Second Choice Committee
*
Please Select
SOCHUM
HCC
UNEP
CELAC
First Choice Position
*
Third Choice Committee
*
Please Select
SOCHUM
HCC
UNEP
CELAC
First Choice Position
*
Why did you choose these committees?
*
Parent/ Guardian information
Guardian 1
*
First Name
Last Name
Guardian 1 Email
*
example@example.com
Guardian 1 Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Guardian 1 Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Guardian 1 Relation
*
Guardian 2
*
First Name
Last Name
Guardian 2 Email
*
example@example.com
Guardian 2 Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Guardian 2 Relation
*
Registration
*
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