Information Request Form

All fields marked with a red asterisk (*) must be filled out.

Parent(s)/Guardian(s) or Independent Adult

Please enter the requested information for each parent/guardian or for yourself if you are an independent adult. There must be at least one parent/guardian or independent adult listed below.

#	First Name*	Last Name*	Email Address*	HSLDA Member
1
2

HSLDA Member Number (if applicable):

Mailing Address* Check here if this is an international address.	Please put your entire address here, and also be sure to fill out the country below.
City*
State*
ZIP*
Country, if other than USA
Phone*

Student(s) (Dependents of adults listed above)

# of students:	First Name*	Last Name*	Birth Date*
1
2
3
4
5
6

Additional Comments

*AP is a registered trademark of the College Board, which was not involved in the production of, and does not endorse, this product.