Indiana University Dance Marathon

Register

Child's Name:
Child's Birthday:	(mm/dd/yyyy) \| Gender: Male Female
Parent's Name(s):
Address:
City:	St: Zip:
E-mail:	Phone:
	Child's Favorite Activities
	Interesting Fact about Child
	Anything else you would like to share
	Would you like to participate in our Pen-Pal Program? Yes

Indiana Memorial Union, Suite 572 | Bloomington, IN 47405
Phone: (812) 855-6362 | Fax: (812) 855-4461 | E-mail: iudmc@indiana.edu