Samford in Charlotte

Tuesday, October 28, 2025 at 7:00 PM until 9:00 PMEastern Daylight Time UTC -04:00

Red Rocks Cafe: Strawberry Hill in South Park
4223 Providence Rd
Charlotte, NC 28211
United States

Student Information

*Email Address

*Student First Name

*Student Preferred First Name

*Student Last Name

Parent Email Address

*Mailing Address

Country

Street

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*Mobile Phone

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*Birthdate

*Gender

*Current School

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Interest-Academic

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*Total Attendees (including student)

Please provide the first and last names of your guests (not including yourself) as you would prefer them to appear on their name tags.

Guest 1 First Name

Guest 1 Last Name

Guest 2 First Name

Guest 2 Last Name

Guest 3 First Name

Guest 3 Last Name

Guest 4 First Name

Guest 4 Last Name