2014 Open House Registration

Enrollment Services

200 University Parkway, Suite 420

Yakima WA 98901

Phone: 509.249.7888

Fax: 509.249.7907
2014 Open House Registration Saturday April 5th 1:00 pm-5:00 pm
Please use this form to register for the open house if you are a prospective medical student, accepted medical student for fall 2014, a pre-medical advisor/faculty member, or a high school faculty member/administrator. If you plan to bring family members or friends, please list them on your registration form under "Additional Attendees." If your guests are prospective medical students, please have them register on their own registration form
Name (Please check spelling)*

First NameLast Name
E-mail*
Re-Enter E-mail*
Phone*

Area CodePhone Number
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
I am attending as*

Prospective Medical StudentCollege Pre-Medical Advisor/FacultyHigh School Faculty/Administration
Additional Attendees
Name of family member / friend attending with me #1

First NameLast NameSuffix
Name of family member / friend attending with me #2

First NameLast NameSuffix
Name of family member / friend attending with me #3

First NameLast NameSuffix
I received (will receive my Bachelor's degree from:*
Month and Year of Graduation*
I plan to start medical school in the year:*
Your Title*
School District, College or University of employment
Please select the 3 breakout sessions you would like to attend.
Breakout Session #1*
Breakout Session #2*
Breakout Session #3*
TOURS: Our current students will be offering guided campus tours 12:15 pm and 5:00 p.m. These tours will take approx 30 minutes. If you would like a campus tour, and you are planning to participate in the Run For Your Life 5k fun run, please select the 5:00 pm tour. If you do not plan on participating in the fun run, please select the tour that best fits your travel schedule.*

11:30 AM12:00PM5:00 PM
Our students sponsor the annual PNWU Run For Your Life 5K fun run. It is open to everyone. The race will begin at 9:00 am in downtown Yakima. Do you plan on participating in the fun run this year?*

YesNo
Click on the link below to register for the Run For Your Life 5K fun run

http://rfyl5k.org
Our students sponsor the annual PNWU Community Health Fair. The fair will begin at 10:00 am, and is being held in downtown Yakima. Are you planning to attend the student-sponsored community health fair?*

YesNo
Should be Empty:

2014 Open House Registration Saturday April 5th 1:00 pm-5:00 pm

Additional Attendees

Please select the 3 breakout sessions you would like to attend.