IIMF Middle School Registration Collaging Your Dreams and Desires Saturday, December 20, 202510:00 AM - 11:30 AMDMACC Urban Campus Building 7 Room #1701144 7th Street, Des Moines, IA

Student Name

First Name

Last Name

Student Email Address (noname@noname.com)

Student Phone Number (xxx-xxx-xxxx)

Gender

School

Graduation Year

If you picked "other" for Middle school, please enter the name below.

Parent/Guardian Information

First Name	Last Name
Phone Number (xxx-xxx-xxxx)	Email (noname@noname.com)