Lyceum online registration
	Please complete the following and return to the Continuing Education Department
	** You will be contacted by Continuing Education to complete your registration **
	First name	Last name	College and grad year
	Mailing address
	City	State/Province	Country	Zip
	Daytime telephone	Fax number	Email address
	Check all that apply to primary registrant: (for name tag ribbon)
	ADIO/PCSC   Alumni association member  Ambassador  Board of Trustee D.C.
	Faculty FSCO Chiropractic studentRegentWCCS
	Class steward Class reunion, please indicate year:
	One day  Childrens program, indicate # children:		Guests:
	Banquet, please indicate how many tickets:
	* Due to catering guarantees, banquet tickets only available until 3pm on Friday
	Alumni reunion reception: D.C. $10.00 / guest $10.00
	Alumni association luncheon: member (free) / guest $10.00
	Regents breakfast: (invitation only) / guest (no charge)
	Guests first and last names (please inidcate child, guest, or spouse)