Kansas State Debate

High School > Wildcat Debate Workshop > Wildcat Debate Workshop Registration Form

Please fill out the following form to assist in your workshop registration. Your information will remain confidential. All information will be emailed to the Director of the Workshop, Justin Green at jmgreen@ksu.edu. If you desire to mail in your registration and not complete the online registration, please print out this page and mail to:

Justin Green - WDW

Communication Studies - KSU

136 Nichols Hall

Manhattan, KS 66506

Your Name:

Your Email Address:

I plan on attending:

 1-week on campus $650 2-week on campus $1200 1-week commuter $450 2-week commuter $750

I qualify for the following discounts

$50 WDW Returning Debater $25 Partner attending

$25 School Spirit - Your school sends three or more debaters.

In 2011-2 school-year I will be a:

 Senior Junior Sophomore Frosh Other

social security number:

 (this is necessary for access to certain databases - it will not be shared except with the Kansas State Library and Internet systems officials - you may choose not to give this)

School Name:

Coach's Name:

Phone Number:

T-Shirt Size (Small-3xl):

Years of Debate Experience:

Partner's Name(if any...):

Roomate Preference (if any...)::
Please list your top 5 debate accomplishments
While at Debate Institute I would like to work on....

Home Address:

City, State, Zip Code:

I would like to attend religious services:

 Yes No

If yes, where?
EMERGENCY CONTACT In the event of an emergency, please provide us with contact information.
Name
Relation
Work Phone
Home Phone
Cell Phone
Name #2
Relation
Work Phone
Cell Phone
HEALTH INFORMATION INFORMATION WILL BE KEPT CONFIDENTIAL!!!
Health Insurance Company
Health Insurance Number
Allergies
Current Medications
Please provide any other medical info

Please advise of any medical conditions the staff should know: