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CIY Mix 2023 | Middle School on Monday, June 19, 2023 @ 7:00 AM

Price:

*Attendee's First Name:

*Attendee's Last Name:

*Attendee's Email Address:

*Attendee's Phone Number:

Country:

Address Line 1:

Address Line 2:

City, State Zip:

Fill out the form below to register for CIY Mix.

*Student's First and Last Name:

*Student's Cell Phone Number:

*Parent/Guardian First and Last Name:

*Parent/Guardian Email Address:

*Parent/Guardian Cell Phone Number:

*Grade Student Enters Fall 2023:

*Student's Biological Sex:

*T-shirt Size:

*List all allergies and medications (If no allergies, type "None"):

Registration Total: