2024 Future PharmeRx Day Registration

OUCOP Future PharmeRx Day Registration

The OUCOP Future PharmeRx Preview Day will be on Saturday, June 8, 2024 beginning at 9:00 am and ending by 1:00 pm that day. This event will be held on the OU HSC campus in OKC and will be FREE. This event is open to middle school and high school students (Grades 8-12) who register by the deadline of Sunday, May 26, 2024.

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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. Please enter your date of birth.

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* 3. What grade are you in?

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. If you are 15 or younger, you must be accompanied by a parent or guardian. Please acknowledge this below.

I acknowledge this, and a parent or guardian will be attending with me.

Unfortunately, I will be unable to attend.

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* 6. 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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* 7. 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.)

2024 Future PharmeRx Day Registration

OUCOP Future PharmeRx Day Registration

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* 1. Please complete all fields below.

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* 2. Please enter your date of birth.

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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. If you are 15 or younger, you must be accompanied by a parent or guardian. Please acknowledge this below.

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* 6. Please list your emergency contact.

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

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* 8. How many total people (include yourself) will be attending?

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

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* 10. How did you hear about this event?