PATH Registration Form

First Name
  

Last Name
 

Address Line 2
 

City
 

State
(Select) Alabama Alaska American Samoa Arizona Arkansas Armed Forces Americas (except Canada) Armed Forces Europe, Canada, Africa, Middle East Armed Forces Pacific California Colorado Connecticut Delaware District Of Columbia Federated States Of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming  

Zip Code
 

Home Phone
 

Cell Phone 
  

Business Phone
 

E-mail Address
 

Preferred method of contact: 

Occupation
 

Employer
 

Your relationship to Hendrix (check all that apply): 

Alumnus/ae, class of 
Former student
Friend 
Parent of  

I’m interested in the following:
(You will only be asked to attend college fairs or host events in your area.)  

College fairs 
Telephoning or emailing prospective students 
Telephoning or emailing parents of prospective students 
Hosting a reception for prospective students and parents in my home or a nearby facility 
Hosting a send-off party for entering freshmen in my home or a nearby facility 
Attending awards assemblies
Having my e-mail address or phone number available as a resource for prospective students or their parents 

I'd like to receive more information on: