Allied Health Science Day

Registration Information

I am registering as a(n):

Individual

School Group

First Name

Last Name

Email Address

Birthdate

Mailing Address

Country

Street

City

Region

Postal Code

Mobile Phone

I would like to receive text messages from Shawnee State University

Yes

No

High School Attended

Graduation Year

What is your intended major or areas of interest?

Including yourself, how many will attend? (Required)

School or Organization Name:

Academic Levels:

10th Grade

11th Grade

12th Grade

Check-in will run from 9am - 9:30am with the welcome beginning at 9:30am. What time will your group arrive?

9:00am

9:30am

10:00am

Estimated number of students attending:

Contact Name:

Contact Title:

Contact Phone:

Contact Email:

Please list any accommodations needed: