College of Pharmacy Open House Registration

October 20, 2017 \ February 2, 2018


OH Event Date
First Name
Last Name
E-mail Address
Street Address
City
State
Zip Code
Date of Birth (MM/DD/YYYY)

Are you a current HS or college student?
Name of Undergraduate School or High School
Major (if applicable)

Anticipated Fall Enrollment
Number of Guests
Special Accommodations (if needed)