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School of Medicine Residency Program Fair

RESIDENCY PROGRAM
Exhibit Application Form
Thursday, August 14, 2014


Exhibit application forms should be received by Friday, July 25, 2014.

Price is $200 ($150 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 Debdeep Banerjee or Ann Bass

When: Thursday, August 14, 2014, 9:30am - 3pm (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:  
 
Email:  
 
Phone Number:

Street Address:  
 
City:  
 
State:

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: