Roseman ASDA's 2023 Pre-Dental Day

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Please complete this form and submit your payment to secure your spot for Pre-Dental Day on November 11th!

This is an in-person event in South Jordan, Utah!

First Name *

Last Name *

Email Address *

What is your current or most recently attended school? *

What is your current year in school? *

Freshman-Sophomore

Junior-Senior

Postbaccalaureate

Other:

What is your application status? *

I have applied in the '23 cycle

I will be applying in the '24 cycle

I will be applying in the '25 cycle

Other:

Where are you traveling from? *

I have paid the non-refundable $45 event fee to @ROSEMANASDA on Venmo that includes your name and "Pre-Dental Day 2023" *

Yes

I am going to do that right now

I want to pay another way (we will contact you!)

Dietary Restrictions *

Vegetarian

Vegan

Kosher

Halal

Gluten-free

None

Other:

Select one of the following: *

I accept the terms of this Assumption of the Risk & Code of Conduct on behalf of myself.

I DO NOT accept the terms of this Assumption of the Risk & Code of Conduct and will not participate in this meeting.

Type your full name below, which serves as your e-signature. *

Submit

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