Slice of Logan
  Saturday, June 21, 2014
8:30 am until 2:30 pm
Logan University
Additional Dates: Saturday, October 04, 2014 and Saturday, March 28, 2015
Please complete the following registration form:
(* indicates required information)
Slice of Logan
 

* Please indicate the date you will attend: 
  Saturday, June 21, 2014
Saturday, October 04, 2014
Saturday, March 28, 2015

* Will you bring a guest? 
  Yes
No

* I would like to attend the reception the evening prior.  
  Yes
No

* Will you bring a guest to the reception? 
  Yes
No

* I am interested in the following degree program: 
  Doctor of Chiropractic Program
Doctor of Chiropractic & Masters of Science Combined Program (MS/DC)
Masters of Science Program Only
Undergraduate
Accelerated Science

Please make a reservation for my FREE** night stay at a local hotel.
(An additional night is available at Logan's corporate rate.) 

* Night(s) to stay in hotel: 
  The Friday night before the event
The Saturday night after the event
Both Friday and Saturday nights
I do not require reservations

Please include any additional night(s) requested
   
**FREE night stay in hotel is available to our guests who live outside the St. Louis Metro Area. 

* Type of room requested: 
  2 Queen Beds
King
Non-Smoking
Smoking (If Available)

* Full Name? 
   

* Address? 
   

* City? 
   

* State? 
   

* Zip Code? 
   

* Phone Number? 
   

* Email? 
   

* Number Attending? 
   

* School/College? 
   

* Expected Entrance Date (ex. Fall 2013)? 
   

Questions or Comments: 
 
For further information, please contact: (636) 227-2100 or (800) 533-9210