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
Cell Phone
E-mail
Social Security Number
(no dashes)
Passport Number
Passport Expiration Date
Date of Birth
(no spaces - mmddyyyy)
Male or Female
Citizenship
If you are not a citizen of the U.S., are you a permanent resident of the U.S.? 
Yes - if yes, submit a copy of your permanent resident card to Mary Bunch.*
No

Country of Birth
Are you a
Law Student
Regent Law Student

If "Law Student," law school or university attending
No. of Semesters Completed by next June
Emergency Contact Name:
Emergency Contact Number:
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 $
   
Are you bringing your spouse and/or child(ren)?
Yes No

*If applicable, send checks, letters of good standing, and permanent resident cards to Strasbourg Study Abroad Program, Attn: Mary Bunch, RH 225, Regent University School of Law, 1000 Regent University Drive, Virginia Beach, VA 23464.