students

student registration form

The questions below are important. Not because we want to hunt you down and sell you things, it's because we're trying to find out how to make this program more of what you want. So, please bear with the questions, and answer what you will.
Please Note: This form will register you, but the Username and Password you submit below will be sent to the email address you fill in below at a later date.
(Fields with * are required)

BuzzFree ID

Your First Name

Your Last Name

Street address

City

State

Zip

Phone Number

(xxx) xxx-xxxx

Name of your school

Your grade level

Your gender

Your birth date

mm/dd/yyyy *

Date of Prom

(mm/dd)

Do you plan on attending college?

Yes No

What sports are you involved in at school? (Please check all that apply)

	Football
	Soccer
	Basketball
	Track & Field
	Volleyball
	Tennis
	Swimming

	Softball
	Golf
	Hockey
	LaCrosse
	Wrestling
	Other

If Other, please tell us:

What clubs or other organizations are you involved in at school? (Please check all that apply)

	Foreign Language
	English
	Speech
	Business / Finance
	Social Sciences
	Math / Science
	Computer Science / Technology

	Religious
	Political
	Cheerleading
	Music
	Art
	Theater
	Other

If Other, please tell us:

How did you hear about the BuzzFree Prom?

	Internet
	Student
	Magazine
	Newspaper

	TV
	Radio
	School
	Other

If Other, please tell us:

Please choose a Username that will be your
unique Log In (5-10 characters or numbers)

Please choose a Password that is unique
to you (5-10 characters or numbers)

Please click here to submit your registration