PT Major Day Registration Form

*Only students interested in studying Physical Therapy should attend PT Major Day. All other students should register to attend our LVC Discovery Day program.
*Event Date: 
*First Name: 
*Last Name: 
*Email Address: 
*Address: 
*City: 
*State:  *Zip: 
*Telephone: 
*High School: 
*Class rank: 
*Year of Graduation: 
College Attended:
Possible major: 
*Extracurricular Activities: 
*The email used to register will be used for all future correspondence.