UMass Amherst: Newman Catholic Center

Newman Catholic Center at the University of Massachusetts

Student Registration Form

Graduate and Undergraduate Students!
Use this form to register with the Newman Catholic Center on-line.
It's fast, easy and secure. Catholic or not, everyone of good will is welcome to become a member of the Newman Community!

There are only a few fields that are "required", but please take a few moments to look over the optional sections and tell us about your interests.

Student Information: * required field

Last Name:		*
First Name:		*
Middle Name:
Local Address: Dorm or Of Campus
Dorm / Street Number:		*
Dorm / Street:		*
City:		*
State:		*
Zip Code:		*
Permanent Home Address:
Street Number
Street
City:
State:
Zip / Postal Code:
Country:

Male	Female	Birthday:	/ / YYYY
Phone / Cell:		() -
Email: (required for receipt)		*
Instant Messaging:

What are you interested in? (check as many as you want. When in doubt, check it!)		Sign me up for the Newman Student Association NSA

Additional Information

Home Parish Church:
City:
State:
Address of Parent or Guardian: (Optional)
	Last Name:
	First Name:
	Street No.:
	Street:
	City:
	State:

472 North Pleasant Street - Amherst MA 01002 - Tel. 413.549.0300 - FAX 413.548.9182 - Email: newmanumass@gmail.com

Last update: Wed, 23 Apr 2008