Regent University -> Information Session -> Virginia Beach Registration Form

Regent Home

Info Sessions Home

----- ----- -----

Virginia Beach Campus

Directions: V.B. Campus

Washington, D.C. Campus

Directions: D.C. Campus

Virginia Beach Information Session Registration Form

Name:*
Address:*
City:*
State:*
Zip:*
Phone:*
E-mail:*
I am interested in the following school at Regent:
Anticipated Enrollment Date:
Guest's Name(s):
How did you hear about our Virginia Beach Information Session?:*	Direct Mail Radio Television Virginian Pilot Daily Press Regent website Friend Other
I would like an admissions counselor to contact me:	Yes by Phone Yes by E-mail No
Comments/Questions:



1000 Regent University Drive, Virginia Beach, VA 23464 800.373.5504 \| 757.352.4127 Contact Us \| Privacy \| © 2008