Student Registration

Please note that all information collected within the form is confidential and will only be retained during Enlightened Challenge. All personal information will be destroyed/removed from the servers at the conclusion of the Challenge.

Team Name *

School or Organization *

Student Name *

First

Middle

Last

As it appears on Driver’s License or other form of official ID

Student Email *

Date of Birth *

Country of Citizenship *

Social Security Number (SSN) *

Do NOT include dashes. Social Security information is required in order to obtain base access for the final event. If you have any concerns, please contact the event coordinator. If you do not have a SSN, please put N/A.

Driver's License Number *

Please provide if you are intending to drive on base.

Driver's License Issuing State *AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Resume Upload *

Click or drag a file to this area to upload.

Click or drag a file to this area to upload. Only .doc, .docx, and .pdf files will be accepted.

Address

Address Line 1

Address Line 2

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Additional Comments

Follow-up *

• Please contact me about more AFRL events
• Please do not contact me

Submit