Samford in Huntsville

Thursday, November 13, 2025 at 7:00 PM until 9:00 PMCentral Standard Time UTC -06:00

Lux Cafe
8141 Madison Blvd
Madison, AL 35758
United States

Student Information

*Email Address

*Student First Name

*Student Preferred First Name

*Student Last Name

Parent Email Address

*Mailing Address

Country

Street

City

Region

Postal Code

*Mobile Phone

Home Phone

*Birthdate

*Gender

*Current School

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Interest-Academic

*Entry Term

*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