Enrollment Form: Hands-on Course in Tablet Technology

Thank you for your interest in attending the University of Tennessee Health Science Center (UTHSC) College of Pharmacy's Hands-on Course in Tablet Technology. The course is taught on the UTHSC campus near downtown Memphis.

There are three opportunities for you to take this course in 2010: March 14-19, June 6-11, or September 12-17.

The course fee is $3,000. After you successfully finish your online registration below, you will receive a confirmation notice from us in your browser regarding the payment and hotel reservation.

Select a course date:

First Name: Last Name:

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Highest Degree Attained:

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Sex:

Dietary Preferences: Are you a vegetarian?

Which of these best describes the type of organization in which you are employed:

Which of the following best describes the nature of your duties/responsibilities: 

If you answered "Other," or wish to clarify your answer to the previous question, you may do so below. If you have any additional comments or questions, feel free to add them here as well:

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Final Steps

Please check your information and print this page before clicking "Submit". If there are any problems submitting this form, please contact Beverly McCray at (901) 448-6092.

To complete the submission of your patient application form, in the space provided below, please type in the 2 words pictured, then click the “Submit” button. Thank you for your submission.