2019 Health Careers Day on the Hill Registration
Type of Registrant*IndividualGroupName*
Phone*Parent/Guardian Contact Information (For Individual Registrants Only)If you are a student registering, please provide your parent/guardian's name, phone number, email address, and mailing address.Name of High School/Group Organization*High School/Group Organization Address**If you are a parent/guardian registering a student, please insert your personal address in this field.Student Registration*
Registration fees are $30.00 per student. Please indicate number of students. NC-HCAP will send an invoice to the email provided above for payment submission to be made by money order or check. Chaperone Registation*
Registration is FREE per chaperone. Please indicate number of chaperones.