Plant Science and Technology Discovery Day

Monday, June 17, 2024Central Daylight Time UTC -05:00

*=Required field

Number attending (including student)*

Student's First Name*

Student's Preferred First Name

Student's Last Name*

Student's Birthdate*

Student's Email Address*

Parent or Other Email Address

Student's Mobile Number

May we text you at this mobile number?

Yes

Home Phone Number

Current School*

High School Grad Year*

Major Interest

Dietary Needs or Accommodations

Do you have any allergies, dietary restrictions or require accommodations? If yes, please outline below.

Emergency Contact Information

Emergency Contact Name

Emergency Telephone Number

Photography Release

I hereby release and discharge The Curators of the University of Missouri, a public corporation, its

successors and assigns, its officers, employees and agents, and the members of the Board of Curators,

from any and all claims and demands arising out of or in connection with the use of such photographs,

film or tape, including but not limited to, any claims for defamation or invasion of privacy.

University of Missouri System students consent to the release of said videotape, audio recordings, film,

photographs or any other medium for the above-stated purposes and in accordance with the terms

state above, pursuant to the consent provisions of the Family Educational Rights and Privacy Act, 20

U.S.C. 1232 et seq.

I agree to the above release.