Fayetteville State University

Captain of My Destiny

Location: Rocky Mount Preparatory School

REGISTRATION
Wednesday, March 6, 2013
Rocky Mount, North Carolina

Registration Form - must be completed in its entirety to successfully register for the Information Session
First Name Last Name
Name of organization
(if applicable)		 How many will participate in the information session?
Street Address City
State Zip
Current High School or College  
Year of Graduation    
Contact Person Primary Phone Number
Alternate Phone Number Email
 
All information is kept confidential and will not be distributed outside FSU.