*First Name:

*Last Name:

Pronunciation of name/
phonetic spelling:

Male or Female:

Address:

City/State/Zip:

*Telephone:

*E-mail:

Birthdate:

*Sports Event:

*Date of Event:

Who are you registering for? (self, parent, grandparent, friend, other):

An interesting fact (favorite Hawkeye player, sport, team or moment):

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