Open House Registration

*Choose which date to attend:

*First Name:

*Last Name:

*Email:

*Confirm Email:

*Birthdate:

*Phone Number (including area code):

*Country:

*Street Address:

*City or Town/Province:

*State (For US residents only):

*Zip (For US residents only):

*I am currently a:

*Gender:

*Area of Interest or Major (Let us know the type of class or which faculty you would like to visit during the Open House):

*Student will be spending the night: YesNo *Parents* several area hotels offer special PBA rates.

*Number of Guardians Attending @ $10 each: Siblings, 10th grade or older who wish to spend the night and/or observe a class must submit their own registration form for $35.

*Special needs and requests (meet with an athletic coach *subject to availability, identify dietary needs, etc.) please be very specific: :

*Total Due:

Payment Information

*Name on Card:

*Card Type:

*Card Number:

*Expiration Month:

*Expiration Year:

*Security Code:

Refunds can only be made prior to the registration deadline date as listed at http://www.pba.edu/open-houses. Unfortunately, there can be no exceptions to this policy.

Liability Wavier

In order to request the overnight experience, the liability release form and the media consent form must be reviewed, and accepted.

Click here to view or download the liability release form.
Click here to view or download the media consent and release form.

*Yes, I have read the liability and media consent form referenced above and agree to their contents. I represent and warrant that I am either 18 years of age or older, or the parent or legal guardian of the minor and am fully competent and authorized to execute this Release. I have read this entire Release.:

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