EMail: pre.pharmacy.ucsb@gmail.

com

Member Registration Form

Thank you for joining the University of California, Santa Barbara Pre-Pharmacy Student
Association! Please fill out the following so that we can keep track of your volunteer hours,
expectations, and other information:
Name:

________________________________________________

E-mail:

________________________________________________

Phone:

(_____) _____ - _________

Major: _____________________________________________________Year: _____________

How did you hear about us?

Facebook / Friend / Pre-Health Listserv / Other

If other, please explain: ____________________________________________________

What do you expect from this group? Please briefly explain what types of activities or qualities
you are looking for in this organization.
_____________________________________________________________________________
Do you want to go to pharmacy school?

Y/N

If not, please explain: _____________________________________________________

Which pharmacy schools do you plan to apply to, if applicable?

Which of the following tests would you like more info about from Kaplan Test Prep (optional):
PCAT

GRE

GMAT

LSAT

MCAT

OAT

DAT

Do you plan on taking a year off before your next level of education?

Y/N

Are you interested in running for the executive board during spring quarter?

Y/N

-----------------------------------------For Executive Board Use -------------------------------------------Membership Dues Status: Paid/Unpaid

Date: _________________________