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Intern Registration Form

First Name

Last Name

Nickname

Username

Email

Phone Number

Address

City

State

Zip Code

Country

School or University

Field of Study

Current Student

Yes

No

Graduate

Are you 18 or over?

Yes

No

Tell us about yourself

Are you ok being photographed?

Yes

No

Are you ok with being recorded?

Yes

No

Images and video may be published on social media and broadcasted on television.

I understand

If under 18 does your parent or guardian consent to your participation?

Yes

No

I have to ask

I’m over 18

If under 18 please list a parent or guardian’s and contact information.

Are you a parent or guardian?

How did you learn about us?

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The password must have a minimum of 8 characters of numbers and letters, contain at least 1 capital letter

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