Request a Speaker

To invite a UCSF School of Pharmacy representative to visit your organization to meet prospective students, provide admissions information, and answer questions, please submit the form below at least one month prior to your requested date. All form fields are required.

If your request conflicts with our current schedule, we may ask that your group attend another presentation that is already scheduled in your area.

Who do you represent?

Name of your group or organization

With what college or university is your group affiliated?

Who are you?

Please provide contact information for you and a second person who can act on your behalf in your absence.

Table for filling out a form of contact information

	Primary Contact Person	Alternate Contact Person
Name

Title or Position

Address	address1	address2

Day Phone Number

Evening Phone Number

E-mail address

When and where would you like us to present?

Preferred date and time
Preferred date and time

Two alternate dates and times
Two alternate dates and times

Location (street address, building name, room number)
Location (street address, building name, room number)

Who is the audience?

Description of your group (e.g., college students, pre-pharmacy club, advising staff, high school students, etc.)
Description of your group

Approximate number of attendees



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