Registration

Full Name (as you would like it printed on certification card)*

Date of Birth*

WID (please type "n/a" if not a K-State Student)*

Mailing address (Street, Unit #, City, State, Zip)*

If a KSU department or other organization will be paying, please provide a billing contact name, department, address, phone, and email address

Email address*

Phone number*

Session Date*

How did you hear about us?

Kansas State University