Brain Camp Registration

SUMMER 2019 REGISTRATION

Dates: Mon - Fri July 29 - August 9, 2019
Times: 9am - 4pm
Location: UC Irvine Campus

Student's Name*

First Name

Last Name

Parent/Guardian Name*

First Name

Last Name

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Phone Number*

Parent Email*

Student Email*

Please enter a parent email if student does not have an email address.

School Name*

2019-2020 Academic Year Grade*

Shirt Size (adult sizes)*

Dietary Restrictions

Vegetarian Vegan Gluten-free Dairy-free

Other:

How did you hear about UCI Brain Camp?

Email Social Media UCI Website

Other:

Click "SUBMIT" to enter your payment information.