Golden Apple Foundation

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First Name:

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Last Name:

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Address:

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City:

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State:

*

Zip Code:

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Email Address

*

Phone Number:

- -

School

Are you a Scholar?

yes no

Are You a Fellow?

yes no

If you are not affiliated with Golden Apple,
how did you hear about CORE?

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Do you need on-campus housing during CORE?

yes no

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Do you need housing the night before CORE begins?

yes no

If a friend or colleague is attending CORE,
and you'd like to request them as a roommate,
please provide their name here.

Grade level interest

Check all that apply:
Pre-K - 3 4 - 6 7 - 8 9 - 12

Fee for conference

Would you like to make a donation to the Scholars
Memorial Fund in addition to your registration fee?

$5 $10 $25
Other: $

Total:

*

I would like to pay by:

Credit Card Check

Payments made by check should be sent to:
Golden Apple Foundation, CORE
8 S. Michigan Ave, Suite 700
Chicago, IL 60603

CORE Registration