Online Registration Form

Please fill out all the fields in this form. If only one advisor is attending with your delegation, please leave the Advisor #2 section blank. Doublecheck that all information in this form is correct before submitting; in particular, please ensure that your email address and fax number are entirely correct, as we will be emailing/faxing you to confirm your registration.

All other forms to complete registration, which must be sent to us by mail, are available at the Registration Center.

Thank you for registering!

SCHOOL INFORMATION

Name of institution

Address Line 1

Address Line 2

City

State

Zipcode

ADVISOR #1

Title

First name

Last name

Work telephone number

Home telephone number

Email address

ADVISOR #2

Title

First name

Last name

Work telephone number

Home telephone number

Email address

DELEGATION INFORMATION

Please note that the delegation cap for PMC Chicago is 30 students per school.
Delegation size

After we review this application, we will send you a confirmation by either fax or email. Please select either of those notification options here, and please note that we will also send your delegation's assigned committee slots and Special Programs slots using the method you select here.

Email (preferred)
If you wish to be informed by email, please type the address in the space below:
Email

Fax
If you wish to be informed by fax, please type the number, including area code, in the space below:
Fax

Remember to doublecheck all the above information before submitting!