Registration Form - Pharmacy Preview Day 2017

If you are considering the field of pharmacy, this is a must-attend event for you and your family! In addition to a campus tour, you will have the opportunity to meet with department professors and students, learning more about the pharmacy program. Demonstrations and presentations throughout the day will allow prospective students and parents to interact with faculty and find out if this could be exactly the program for them!
April 7, 2017

Cancel Registration and Return to Pharmacy Preview Day

Note: Red * text indicates required fields

Personal Information

First Name, Last Name *
Address One *
Address Two
City, State, Postal Code *
Phone Number
[999-999-9999 x999]
*
E-mail Address *
Gender   
  
Major Interested in
Birthdate *

High School and Church Information

High School Name *
High School City *
High School State *
Graduation Year [yyyy] *
Church Name *
Church City *
Church State *

Housing Information

If you are coming Thursday, please plan to arrive between 5:00 - 7:30pm.
Time of Arrival (if on Thursday)


Student Housing
          
          

Event Details

Total people attending (please include any parents or siblings who plan to attend) *
Additonal Comments

PAYMENT INFORMATION

Total Amount: $