Member Registration

Please fill out the following form to register with the Catholic Campus Center at Washburn University. All students (new and returning) are asked to complete a new registration card each semester. Please help us stay connected with you by filling in the information below and selecting the programs and activities that you are interested in! Thanks!

Contact Information

Please enter your contact information.
Date REQUIRED Please fill out this field. Please enter a date.
Name REQUIRED Please fill out this field. Please enter valid data.
WIN REQUIRED Please fill out this field. Please enter valid data.
Sex REQUIRED Please fill out this field.
WU Mailing Address REQUIRED Please fill out this field. Please enter valid data.
Email Address REQUIRED Please fill out this field. Please enter an email address.
Phone Number REQUIRED Please fill out this field. Please enter valid data.
Date of Birth REQUIRED Please fill out this field. Please enter a date.
Home Parish Please enter valid data.
Home Parish City & State Please enter valid data.

Education

Please enter the following information about your status at WU.
Anticipated Year of Graduation REQUIRED Please fill out this field. Please enter valid data.
Major REQUIRED Please fill out this field. Please enter valid data.
Class REQUIRED Freshman Sophomore Junior Senior Graduate Student Law Student Other Please fill out this field.

Sacaraments

Please indicated the Sacraments that you have received.
Baptized Yes No
In the Catholic Church Yes No
Confirmed Yes No
Married Yes No
Anniversary Date Please enter valid data.

Parent's Contact Information

Please enter the Name, Address, City, State, Zip and Phone Number that you would like us to contact in case of an emergency.

Parent's Name Please enter valid data.

Parent's Address Please enter valid data.

Parent's Phone Number Please enter valid data.

Getting Involved

Please choose the ministries and activities you would be interested in participating in or learning more about.
Liturgy
Listed below are areas that you can get involved at here at the Center.
Education
Spiritual
Social
Service Opportunities
Thank you!