Username or email address *
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Email address *
Student First Name*- Please use the name you are officially registered with at the university. NO NICKNAMES, PLEASE
Student Last Name*
Student Phone Number*
Pepperdine University Email Address*
PLEASE USE YOUR OFFICIAL PEPPERDINE EMAIL ADDRESS
Alternate Name of Parent or Guardian* Please do not enter the same name entered as student name.
Alternate email address*
Alternate phone number*
Proxy Name (if student cannot be present for pickup/delivery)
Proxy Phone Number (if student cannot be present for pickup/delivery)