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Center for Information Management, Integration and Connectivity
SCIENCE & TECHNOLOGY SUMMER CAMP 2007
 
 
Summer Camp 2007 Registrants List
 
Camper , registered at
 
Camper's Information
First Name:
 Last Name:
 Date of Birth(dd/mm/yyyy):
Home Phone:
 Email:
  
Address:  
Street Apt# City State Zip Code
School Attending:  
School Name School District (City) Grade Completed (June 2007)
 
Parent's Contact Information
Mother/Guardian's Ful Name:
 Phone:
 
Father/Guardian's Full Name:
 Phone:
 
Emergency Contact
Full Name:
 Relationship to Camper:
Phone:
  
 
 
For more information on the camp, please contact Dr. Soon Ae Chun at (973) 353-1014 or at soon@cimic.rutgers.edu