You are hereHome › Georgia Law Summer Program in Brussels & Geneva - Registration Form Georgia Law Summer Program in Brussels & Geneva - Registration Form Personal Information Full name exactly as it appears on passport * Preferred Name Sex * F M Date of birth * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1914191519161917191819191920192119221923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016 Year of law school you will be entering in Fall Semester * Second Third Name of the law school you currently attend * Expected date of graduation * Current address * Permanent address (if different from above) Home phone Cell Phone E-mail * How did you hear about our program? Citizenship/Residency Citizenship * United States Permanent Resident (You will be asked to provide a photocopy of your alien registration card.) Other (specify country of citizenship) Citizenship Other (specify country of citizenship) Visa: If you currently reside in the United States but are not a United States citizen or Permanent Resident, what kind of visa do you hold? Student (F-1) Exchange (J-1) Tourist (B-2) Refugee Other (specify) Visa: If you currently reside in the United States but are not a United States citizen or Permanent Resident, what kind of visa do you hold? Other (specify) In case of an overseas emergency, please contact: Name * Relationship * Address * Emergency phone * E-mail Preferences I would like a single room I would like to have a roommate assigned if possible I would like to room with... Preferences I would like to room with... Please notify us of any special dietary requirements I have read and agree to the payment procedures. I affirm that the information I have provided on this application form is complete, accurate, and true to the best of my knowledge, and I agree to submit other material upon request for this application.