Name:

Campus:

Email Address:

Cell Phone:

Home Address:

City, State, Zip Code:

Do you require vegetarian meals (y/n)?

Gender (M/F)?

Are you involved politically on campus (y/n)?

If so what organization?

Do you consider your self Democrat/Republican/Other (D/R/O)?

Are in a sorority/fraternity (y/n)?

Which so which one?

Do you hold leadership position (y/n)?

If yes what position?