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Event Registration
April 2028 Experience LIFE
Is this an Event Registration?
Yes
No
Bio/Demo Information
If you have any questions please visit our
LIFE Leadership Weekend FAQ's
section of our website.
First Name
Last Name
Email Address
Cell Phone
Date of Birth
*Please note that you must be 17 or older to attend.
Home Phone
Check if address is outside of U.S. or Canada
Address Line1
Address Line2
Foreign Address Line
City
State/Province
Alabama
Alaska
Alberta
American Samoa
Arizona
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California
Canal Zone
Colorado
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District of Columbia
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Marshall Islands
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Military Americas
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Newfoundland and Labrador
No Response
North Carolina
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Texas
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Virginia
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Postal Code
Country
United States
Canada
Afghanistan
Aland Islands
Albania
Algeria
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Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
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Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
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Bhutan
Bolivia
Bonaire, Saint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
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Congo, The Democratic Republic of the
Cook Islands
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Cyprus
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Djibouti
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Dominican Republic
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El Salvador
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Ethiopia
Falkland Islands (Malvinas)
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Finland
France
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Gabon
Gambia
Georgia
Germany
Ghana
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Greenland
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Guyana
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Heard Island and Mcdonald Islands
Holy See (Vatican City State)
Honduras
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Hungary
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India
Indonesia
Iran, Islamic Republic Of
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
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Korea, Republic Of
Kosovo
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Lithuania
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Macedonia, The Former Yugoslav Republic Of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
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Monaco
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Nigeria
Niue
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Palestinian Territory, Occupied
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French Part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
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Saudi Arabia
Senegal
Serbia
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Slovakia
Slovenia
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Somalia
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Spain
Sri Lanka
Stateless
Sudan
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Unknown
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Virgin Islands, British
Wallis and Futuna
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Gender
Female
Male
NonBinary (Genderfluid)
Prefer Not to Answer
Describe your current status
Returning Life University Student
High School Freshman - Sophomore
High School Junior - Senior
Undergraduate College Student
Transfer student from an Undergraduate Institution
Graduate Student
Transfer student from another Chiropractic College
None of the above
Experience LIFE Specifics
Have you previously attended a LIFE Leadership Weekend or Experience Life event?
Yes
No
If yes, when?
You have indicated that you are a returning LLW attendee. LIFE asks that you cover the following expenses:
1. Your hotel stay (one, two or three nights – the duration of your stay is at your discretion)
2. $200 registration fee (which can be paid at registration). This fee covers food, transportation and weekend materials.
How did you learn about this event?
Advisor
Alumni
Admissions Counselor
Buckeyes for LIFE
Chiro Club
Current Student
Dynamic Essentials
Europe - LLW
Faculty/Staff
Mail/Postcard
Fall CE Doctor
Field Doctor
Friend of LIFE
GCA 4 LIFE
Impact Tour
LIFE U Website
LIFEforce Tribe Member
Maximized Living
NYC for LIFE
Other
Social Media
Tarheels for LIFE
Unified for LIFE
Referral's name
Please enter your referring party as FirstName LastName. If more than one person encouraged you to apply to LIFE, please enter their name(s) separated by a comma (,).
What year will you graduate?
Do you have any dietary needs or restrictions?
Yes
No
Do you require special assistance?
Yes
No
Dietary needs or restrictions:
How will you be traveling?
Plane
Drive
Train
Assistance specification(s):
Do you require hotel accommodations?
Yes
No
Do you consent to photo & video during event?
Yes
No
How many guests will you bring?
0
1
2
Are you attending this event with a group from a High School, College, or other Institution?
Yes
No
What is the name of your school, institution, or group?
We strongly recommend bringing a guest. Bring your significant other or a parent. Our guests love this weekend. Guests are welcome to attend all sessions. Life University will cover the cost of one guest, but we ask that each additional guest pay $150 per person. This fee offsets food and transportation costs for the weekend. We collect your additional guest fee(s) during registration, payable by cash, check or credit card. LIFE does not pay for additional hotel rooms for guests of LIFE Leadership Weekend participants.
How did you hear about the Experience LIFE event?
Are/have you worked with a LIFE U Admissions Counselor?
Yes
No
Which Recruiter?
Asia Knox
Baigen Seawell
Carmina Bioc
Cheyenne Selden
Christian Flavin
Christy Shepherd
Danielle Albright
David Scheiner
Edgar Jimenez
Erica Michaels
Erin Brick
Jacqueline Pingul
Jennifer Steinbeck
Jerome Stockwell | Life University
Johkida Jackson
Julia Bush
Julissa Norat
Keith Jordan
Korey Lee
Krystal Burnett
Laura Littleton
Lee Skinkle
Mackel Harris
Magalie Remy
Magi Rodgers
Marcus Pruitt
Monika Autrey
Nicole Lee
Nigar Gafarzada
SaQuinn Barnes
Sawanda Spinks
Sean Subulade
Shemika Withers
Stella Broni
Stephanie Rainey
Tatum Johnson
Taylor Stevens
Tyraun Washington
Club Activity
What Club are/were you most active in at your current/former institution?
None
Biology
Chiropractic
HOSA
Kinesiology
Pre-Med
Other
Club Specifics
Please list the institution and club name.
Are you an Academic Advisor
Yes
No
Which Institution?
Academic Interests
Anticipated Academic Level
Doctor of Chiropractic
Undergraduate
Graduate
Non Matriculated
Post Baccalaureate
Anticipated Academic Program
A.S. In Movement & Human Performance
Associate of Arts & Sciences
Bachelor of Arts in Environment and Sustainability
Bachelor of Arts in Sports Administration
Bachelor of Science in Anatomy & Physiology
Bachelor of Science in Biology
Bachelor of Science in Biopsychology
Bachelor of Science in Computer Information System Technology
Bachelor of Science in Exercise Science
Bachelor of Science in Exercise Science
Bachelor of Science in Health Coaching
Bachelor of Science in Health Science
Bachelor of Science in Interdisciplinary Studies (formerly General Studies)
Bachelor of Science in Nutrition
Bachelor of Science in Psychology
Bachelor of Science in Public Health
Bachelor's in Business Administration
Doctor of Chiropractic
Master of Business Administration
Master of Science in Positive Psychology
Master of Science in Sport Health Science
Nonmatriculated / Non-Degree Seeking
Pre-DC
Location
Main Campus (On-Ground)
Online
Anticipated Entry Quarter
Winter 2027
Spring 2027
Summer 2027
Fall 2027
Winter 2028
Spring 2028
Beyond
Future Anticipated Start Year
Future Anticipated Term
Winter (Jan)
Spring (April)
Summer (July)
Fall (Oct)
How did you learn about LIFE U?
Current Student
Faculty/Staff Member
HS/College
Recruiter
Organization/Association
Social Media
Other
Which Recruiter?
Asia Knox
Baigen Seawell
Carmina Bioc
Cheyenne Selden
Christian Flavin
Christy Shepherd
Danielle Albright
David Scheiner
Edgar Jimenez
Erica Michaels
Erin Brick
Jacqueline Pingul
Jennifer Steinbeck
Jerome Stockwell | Life University
Johkida Jackson
Julia Bush
Julissa Norat
Keith Jordan
Korey Lee
Krystal Burnett
Laura Littleton
Lee Skinkle
Mackel Harris
Magalie Remy
Magi Rodgers
Marcus Pruitt
Monika Autrey
Nicole Lee
Nigar Gafarzada
SaQuinn Barnes
Sawanda Spinks
Sean Subulade
Shemika Withers
Stella Broni
Stephanie Rainey
Tatum Johnson
Taylor Stevens
Tyraun Washington
High School or College Name
Which Organization or Association?
Alumni or Friend
LIFEforce Tribe Member
Georgia: Georgia 4 LIFE
Dynamic Essentials
Maximized Living
Ohio: Buckeyes for LIFE
New York: NYC LIFE
North Carolina: Tarheels for LIFE
Virginia: Unified with LIFE
Wisconsin: Badgers 4 LIFE
If other, how/where did you learn about Life University?
Name of referring party
Please enter your referring party as FirstName LastName. If more than one person encouraged you to apply to LIFE, please enter their name(s) separated by a comma (,).
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