PharmCORP Registration

PharmCORP Registration
Please fill out the form below to register for PharmCORP. This event will be held at Southwestern Oklahoma State University College of Pharmacy in Weatherford, Oklahoma on Saturday, September 20, 2025. The registration deadline is September 5, 2025, at 11:59 pm.

There is a registration fee of $25 which can be paid using Venmo after filling out this form or by check payable to Kappa Epsilon & postmarked on or before the Sept. 5th deadline.
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Age*
Enter your age.
Grade*
Enter your current grade.
School*
Enter your school name.
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
List any allergies
Allergies
List any medications
Is the student taking any medications?
Dietary Restrictions Choice Form Element

NoneVegetarianVeganKosherGluten-freeOther
If other, list
List for "Other" option.
T-shirt Size*

SMLXLXXLXXXL
Interest in the pharmacy profession (1=lowest, 5=highest)*

12345
Parent/Guardian (Emergency Contact)*

First NameLast Name
Emergency Contact Email*
example@example.com
Emergency Contact Phone Number*
Please enter a valid phone number.
Payment Method

The registration fee is $25. You may pay using Venmo (@Kappa-Epsilon-4) or by mailing a check or money order to:

Kappa Epsilon PharmCORP

SWOSU College of Pharmacy

100 Campus Drive

Weatherford, OK 73096
Payment Method*

Check or Money OrderVenmo (@Kappa-Epsilon-4)
Should be Empty:

PharmCORP Registration

Payment Method