An Evening with Rural Pre-Medicine

Please let us know if you are able to attend an Evening with RPM.

Name Name First Last
You would like to attend:

You would like to attend: Virtually In-person
Email (for remote attendance, the provided email is where we will send the Zoom link before the event)
Phone Phone - ### - ### ####
Your high school (if applicable)
Grade in high school (due to its popularity, this event may be limited to Grade 11 and 12 students).

Grade in high school (due to its popularity, this event may be limited to Grade 11 and 12 students). Grade 11 Grade 12
Will anyone be joining you? A parent or other significant person?

Will anyone be joining you? A parent or other significant person? Yes, please! No, thank you.
Please let us know the name(s) of your guests.
I'm interested in attending virtually

I'm interested in attending virtually Yes, please!