Strasbourg Study Abroad Program

Note that registration is complete when the $250 non-refundable deposit is received.

If you are bringing your spouse and/or child(ren), you must also fill out this form for each family member.

First Name
Last Name
Address
City, State, ZIP
Day Phone
Evening Phone
Cell Phone
E-mail
Social Security Number
(no dashes)
Passport Number
Passport Expiration Date
Date of Birth
(no spaces - mmddyyyy)
Male or Female
Citizenship
Country of Birth
Are you a

Law Student
Regent Law Student

If "Law Student," Law School attending
No. of Semesters Completed by next June
Note: If you are a law student who is not attending Regent University School of Law, then please have your Dean's office mail a "Letter of Good Standing" on official school letterhead.
Pay Deposit Online Now
Pay by Check Later
Amount $