* Required

Your First Name*required

Your Last Name*required

Your Preferred Name (for nametag)

Your Email*required

Your Cell Phone Number (include area code)*required

Your relationship to Canterbury?*

(Check all that apply)

Trustee  Alumnus/a  Parent of Current Student(s)  Parent of Alumni  Grandparent of Current or Former Student(s)  Faculty or Staff  Former Faculty or Staff  Friend of the School  Other 

Your Class Year*required

Please Select…19401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022

Address 1*required

Address 2

City*required

State*required

Please Select…AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AfricaArmed Forces AmericasArmed Forces CanadaArmed Forces EuropeArmed Forces Middle EastArmed Forces Pacific

Zip*required

Number of Attendees*required

($25 per person)​​

Please Select…1234

Total Amount Due

Please provide the name(s) of your guest(s):

Guest 1 Name*required

Guest 2 Name*required

Guest 3 Name*required

Please send a confirmation email to the address below*: