Open House Preregistration Form

Important Notice

Sign-up for our Fall 2012 programs will be available after the July open house. Please check back.

Tell us about yourself...
To expedite your check-in process, we ask you to complete our on-line form. Please fill out a separate form for each STUDENT attending. If you would like to sign up by telephone, please call us at (217) 581-2223 or (877) 581-BEIU (2348).
* denotes required fields.
Last Name*:
First Name*:
Address*:
Address (Line 2):
City*:
County*:
State*:   Zip*:
Phone*: () -
Date of Birth*: (ex. 6/20/1988)
E-mail*:
We will send a reminder one week prior to the event.
Optional Information:
Gender: Male   Female
Ethnicity: