School of Medicine Residency Program Fair

Exhibit Application Form
Monday, August 22, 2016

Exhibit application forms should be received by Friday, August 12, 2016.

Price is $200 ($100 for TTU/TTUHSC Departments) and includes one eight foot table with tablecloth, breakfast, lunch and snacks for two attendees.

For TTUHSC Departmental Payments, please contact Pam Prosser @ 806-743-2300 ext. 226 or pam.prosser@ttuhsc.edu

If you have more than two attendees OR need more information, please contact Sabrina Siddiqui

When: Monday, August 22, 2016, 9:00am - 2:00pm (check in begins at 8:30am )

Where: Academic Classroom Building Lobby, Texas Tech University Health Sciences Center (Lubbock, TX)

First Name:  
Total: $200.00

Last Name:  
Phone Number:

Street Address:  

Zip Code:  
Are you part of Texas Tech University System?
If yes, Department Name:  

Name of Residency Program:  

Name of Residency Director:  

Name of first attendee:  

Name of second attendee:  

Special Requirements:  

Dietary Restrictions: