Register for Exploration Days - Mitchell Technical Institute

Name: *
Address: *
City: *
State:
Zip: *
High School:
Year of Graduation:
Cell Phone:
Home Phone:
E-mail:
# of People Attending:
Today's Date:
I am a high school:	Senior Junior
What date would you like to participate?:
First program of Interest (required):
Second Program of Interest (optional):

I certify that the information in this application is true and complete to the best of my knowledge. Do you agree with the statement above?
Please check the box: *	Yes I agree
All applications will be automatically dated upon electronic submission.