2017 UCR School of Medicine Open House Group RSVP

Thank you for your interest in the UC Riverside School of Medicine 2017 Open House on Saturday, April 8, 2017 from 8 a.m. to 12 noon.

Please use this form if you will be bringing a 10 OR MORE INDIVIDUALS, INCLUDING CHAPERONES. If you are bringing fewer people, please use our other form https://www.surveymonkey.com/r/ucrsom2017rsvp.

If you have any questions regarding this event, please email peggy.earley@ucr.edu

You can get directions to the School of Medicine Education Building and nearby Lot 13 by using this link to Google Maps.

The open house will be held rain or shine.

Please complete the following information:

Your Contact Information

* 1. First Name

* 2. Last Name

* 3. Title

* 4. E-mail Address (This will be used to send any program updates. If you need to include multiple e-mail addresses, please separate with a semicolon).

* 5. Phone Number (with area code)

Group Information

* 6. Name of School, Group or Organization (if applicable)

* 7. Affiliation (select all those that apply)

* 8. Total Number of Attendees

* 9. Transportation

* 10. Special Accommodations: Please specify if any special accommodations will be needed due to a disability:

* 11. How did you hear about the Open House?