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School of Medicine

School of Medicine Open House Registration

NOTE: You must complete all fields of this form in order to submit the registration.

Name:

Address:

City:

State:

Zip code:

Day Telephone Number:

Preferred e-mail address: (please be specific, i.e: tsmith@kumc.edu)

I am registering for the Open House on

Friday, November 13, 2009

Please Indicate Your Level of Education:

High School:

College:

Name of your School:

Open House Registration Information:
Amy Meara, email ameara@kumc.edu
University of Kansas School of Medicine
Phone: (913) 588-5280

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