JSHS Director Registration

JSHS regional directors, or their designated representative, must pre-register:

1) five (5) student delegates; and 2) one (1) adult leader/chaperone who will attend National.

Pre-registration should immediately follow the completion of the regional symposium or no later than two weeks following the symposium. Following pre-registration, direct attending students and and adult leader / chaperone to the JSHS website to complete the registration process.

Note: An AUTHORIZATION CODE will be issued upon completing pre-registration. GROUP records may be accessed at any time with this code. INDIVIDUALS access registration with SSN.

 

This pre-registration form has been completed by:
Date of pre-registration and request for airline tickets: 2010-07-30 15:52:17

Important Note: To avoid delays in boarding your airline flight you should be sure the "first name with middle initial or middle name" and "last name" as appear on this form are the same as appear on the form of identification you will be using to board your airline flight.

Regional director first name with middle initial or middle name:
Last name:
Your Social Security Number:
Your email address:
Choose your regional symposium:

 
Adult leader/chaperone
First name with middle initial or middle name:   Legal last name:
Email address:
Social Security Number:
Closest major airport is in what city?

Arrival (ie. arrival to symposium):
Date:
     (in the form of yyyy-mm-dd)

Note any time restrictions or special requests:
 Departure (ie. arrival from symposium):
Date:
     (in the form of yyyy-mm-dd)

Note any time restrictions or special requests:

 


Student delegates

Student #1

First name with middle initial or middle name:   Legal last name:
Social Security Number (in the form of xxx-xx-xxxx):
Student Participation:
Email address:
Regional scholarship award:
Closest major airport is in what city?

Arrival (ie. arrival to symposium):
Date:
     (in the form of yyyy-mm-dd)

Note any time restrictions or special requests:
 Departure (ie. arrival from symposium):
Date:
     (in the form of yyyy-mm-dd)

Note any time restrictions or special requests:

Student #2

First name with middle initial or middle name:   Legal last name:
Social Security Number (in the form of xxx-xx-xxxx):
Student Participation:
Email address:
Regional scholarship award:
Closest major airport is in what city?

Arrival (ie. arrival to symposium):
Date:
     (in the form of yyyy-mm-dd)

Note any time restrictions or special requests:
 Departure (ie. arrival from symposium):
Date:
     (in the form of yyyy-mm-dd)

Note any time restrictions or special requests:

Student #3

First name with middle initial or middle name:   Legal last name:
Social Security Number (in the form of xxx-xx-xxxx):
Student Participation:
Email address:
Regional scholarship award:
Closest major airport is in what city?

Arrival (ie. arrival to symposium):
Date:
     (in the form of yyyy-mm-dd)

Note any time restrictions or special requests:
 Departure (ie. arrival from symposium):
Date:
     (in the form of yyyy-mm-dd)

Note any time restrictions or special requests:

Student #4

First name with middle initial or middle name:   Legal last name:
Social Security Number (in the form of xxx-xx-xxxx):
Student Participation:
Email address:
Regional scholarship award:
Closest major airport is in what city?

Arrival (ie. arrival to symposium):
Date:
     (in the form of yyyy-mm-dd)

Note any time restrictions or special requests:
 Departure (ie. arrival from symposium):
Date:
     (in the form of yyyy-mm-dd)

Note any time restrictions or special requests:

Student #5

First name with middle initial or middle name:   Legal last name:
Social Security Number (in the form of xxx-xx-xxxx):
Student Participation:
Email address:
Regional scholarship award:
Closest major airport is in what city?

Arrival (ie. arrival to symposium):
Date:
     (in the form of yyyy-mm-dd)

Note any time restrictions or special requests:
 Departure (ie. arrival from symposium):
Date:
     (in the form of yyyy-mm-dd)

Note any time restrictions or special requests:

 
 
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