2020 Future PharmeRx Preview Day Waitlist
Registration

OUCOP Future PharmeRx Preview Day

Registration for this event is now full. We are taking names for the waitlist on a first-come, first-served basis. Selection from the waitlist will be ranked based on the date/time stamp of submission of this registration. We will notify selected waitlist participants as soon as a spot may become available all the way through February 17. The waitlist registration will CLOSE on February 14, 2020.

The OUCOP Future PharmeRx Preview Day will be on Saturday, February 29, 2020 beginning at 9:00 am and ending by 2:00 pm that day. This event is FREE. This event is open to the first 75 middle school and high school students (Grades 6-12) who register by the deadline of Friday, February 14, 2020. Early registration is encouraged as this event tends to fill quickly.

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* 1. Please complete all fields below.

First Name *

Last Name *

City/Town:

Email Address: *

Phone Number: *

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* 2. What is your age group?

Middle School

High School

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* 3. What grade are you in?

6th Grade

7th Grade

8th Grade

9th Grade

10th Grade

11th Grade

12th Grade

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* 4. If you are currently in school, please list your school and location.

School Name

City

State

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* 5. Please list your emergency contact.

First Name

Last Name

Address

City/Town

State/Province

ZIP/Postal Code

Relationship to You (e.g. mother, father, etc.)

Email Address

Cell Phone Number

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* 6. Please list any allergies or dietary restrictions you or your guests may have.

Allergies (e.g. latex, peanuts, etc.)

Dietary Restrictions (e.g. vegetarian, diabetic, etc.)

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* 7. Will your parents/guardian or an adult be attending with you that day?

I will be attending alone.

My parent(s) will be attending.

My guardian(s) will be attending.

An adult other than my parents/guardian will be attending.

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* 8. How many people will you be bringing? Including yourself.

More - please specify

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* 1. Please complete all fields below.

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* 2. What is your age group?

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* 3. What grade are you in?

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* 4. If you are currently in school, please list your school and location.

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* 5. Please list your emergency contact.

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* 6. Please list any allergies or dietary restrictions you or your guests may have.

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* 7. Will your parents/guardian or an adult be attending with you that day?

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* 8. How many people will you be bringing? Including yourself.

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* 9. Please list the first and last names of all people attending with you.