UW-Madison School of Pharmacy

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Online Registration - Preview Day for High School Students

Preview Day Registration Form

Please fill out the form below and click the 'Continue' button.    
(* Indicates required information.)

Name:*

(First Name MI, Last Name)


Street Address:*

(Street)

(City, State, ZIP)


,

Area Code and Phone:*

(Ex: 123-456-7890)



Email:*


Confirm Email:*


Current High School:*



Year in High School:*

   Freshman
   Sophomore
   Junior
   Senior
   Other (please explain):

Guests:

Please provide the individual name of the parent, spouse, pharmacist, or other guest who will be accompanying you to the program. Because of limited space, and in an effort to accommodate as many students as possible to the Preview Day program, we ask that you limit the number of guests to one (1).

Will you be bringing a guest?
   Yes  No

Guest First Name:
Guest Last Name:


Lunch:

Lunch will be provided to all School of Pharmacy Preview Day registrants and guests. Please indicate if you or your guest has any special dietary requirements.    

Registration For Afternoon Breakout Sessions


Please rank the sessions from 1 to 5 for both you and your guest. (1 = first choice).

The descriptions can be found here. You will be assigned to 1 demonstration and 1 non-demonstration session. Every attempt will be made to assign you to your top preferences, but because of space limitations, this may not be possible in all cases. The information packet you receive upon your arrival will identify the afternoon sessions to which you have been assigned.

Rank/Topic

Your Selected Breakout Sessions
1st Choice:
2nd Choice:
3rd Choice:
4th Choice:
5th Choice:

Your Guest's Selected Breakout Sessions
1st Choice:
2nd Choice:
3rd Choice:
4th Choice:
5th Choice:


Please select how you would like to pay the registration fee.*
Pay by Check
Pay by Credit Card



Note* - If you have chosen to pay by Credit Card, you will be directed to a CashNet site. This site requires that you use the latest versions of your web browser. If you have diffuculty using this site, please try again using a different / more up-to-date browser. For example, Internet Explorer on a Windows XP computer will likely not work.