GAPP Workshop Registration Form


     Gross Anatomy Pre-matriculation Preparation (GAPP) Workshop

    Department of Physical Therapy

    June 6 - 28, 2018
    Mondays - Thursdays, 9:00 am to 1:00 pm

    Registration Form

    Please complete registration form below; however, registration is not complete until payment is received.   Checks may be made payable to the UMES Physical Therapy Department -- "GAPP Workshop" should be written on the check memo line.  Additionally, credit card payments will also be accepted by calling 410-651-6301. A copy of the program acceptance letter must be mailed or e-mailed to the Department of Physical Therapy, University of Maryland Eastern Shore, Hazel Hall, Suite 2093, Princess Anne, MD 21853 or (place "GAPP Program" on the e-mail subject line). Thank you.

    Cost: $400.00 for all current and future UMES students, $500.00 all other students


    Full Name:
    Zip Code:
    Home Phone:
    Cell Phone:
    Email Address:
    I received or will receive my undergraduate degree from:

    I have been accepted to the following school/program:

    Do you have a latex allergy?

    Thank you.