Wisconsin Lutheran Chapel

Class Registration

Note: Required fields are marked with an asterisk (*)

Student Information

First Name*

Last Name*

Gender*
Male Female

Birthday*

Address*

City*

State*

ZIP Code*

Home Phone

Work Phone

E-mail Address* (Enter twice to confirm)

Family Information

Marital Status
Single Married

If you are married, please tell us about your family:

Spouse First Name

Spouse Last Name

Spouse Occupation

Children's Names

Student Background

Home Country*

Home City*

Occupation In Home Country

Occupation in Madison (check all that apply)
Student
School

Area of study

Working
Employer

Homemaker

What degrees do you hold?

How long have you been in Madison?

When will you return to your home country?
(Month & year, e.g. 05/2010)

Student Interests & Transportation

I am interested in:
Attending Chapel worship services with an English-speaking partner
Visiting American family homes, learning American cooking and games

Transportation
I need transportation to and from Chapel on Sunday mornings

Security Word*