Registration Form

Student Info

Student Name *

First

Last

Student Age *

Accepted Ages are 13–18 years old

Parent/Guardian Name *

First

Last

County

Contact Preferences

Phone Number *

Please contact me by *

Email *

Please contact me in the *

Questions, Comments, and/or Suggestions

Layout

KRE8ivU is a not-for-profit company designated 501c3

Lexington, NC

Contact Form

Name *

First

Last

Contact Preferences

Work Email *

Company Name *

Please contact me by *

Phone Number *

Business Type *

Please contact me in the *

Questions, Comments, and/or Suggestions