Registration for the Pre-Pharmacy Society at UGA
(please return to our box located at __________ or to any of the current officers)
* indicate required information
*Name: ___________________________________ Date: _____________
Local Address: _________________________ Phone number: ______________
__________________________
*Email address: _________________________ *Date of birth: ________________
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Please answer the following questions. Their answers will not in any was affect your membership.
1.How long have you been pre-pharmacy? __________________________
2.Are you a: freshman sophomore junior senior (circle one)
3.When are you planning to apply to pharmacy school? ______________________
4.Which pharmacy schools are you planning to apply to?
University of Georgia __________ Mercer University ___________
South University __________ Other (list) _________________
5.Why are interested in pharmacy? _____________________________________
________________________________________________________________
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Dues = $ T-shirts =$ Size: S___ M___ L___ XL___
Total paid $___________ Check # ___________ Cash receipt # ______________
As a member of this club, I agree to take on all responsibilities of membership, including attending meetings and club-sponsored events regularly, and paying dues. This organization is only as good as its members, and therefore, I agree to uphold the by-laws and constitution, promote the organization's cause, and follow the policies outlined by the Department of Campus Life.
I, _________________________, hereby swear that I have read and agree with the above statements and will do my best to comply with the club's expectations of its members. Violations will result in suspension of membership, and if needed, further action by the University.
Applicant's signature _____________________
Date ____________
Bring this to a next meeting OR send it back through pre-pharmacy e-mail.