Administrator Login

Please Complete This Form to Register for the 2009 Black Congratulatory


Registration fee ($45) will be due between: April 20th - April 24th and April 27th - April 30th

PLEASE USE INTERNET EXPLORER TO REGISTER! DO NOT USE MOZILLA, OR OTHER WEB BROWSERS.

You must pay cash/money order made out to the University of Illinois

***Checks Will NOT Be Accepted!***


For questions, call AACC at 333-2092.
For technical difficulties with this form, contact the Webmaster at aacp@uiuc.edu



Name (First, Middle, Last):
UIUC Email Address:
     
Local Address:    
  Line 1:
  Line 2:
  City:    State:    Zip: -
  Phone: () -
   
Permanent Address:    
  Line 1:
  Line 2:
  City:    State:    Zip: -
  Phone: () -
     
Graduation Month/Year: /
First Year Enrolled at UIUC:
   
Special Needs:
List any affiliations:

Honors:
   
College:
Major:
Degree Type:
Minor:
(OPTIONAL)  
Second College:
Second Major:
Second Degree Type:

Registration fee ($45) will be due between: April 20th - April 24th and April 27th - April 30th
You must pay cash/money order made out to the University of Illinois