I plan to attend OHIO University Pickerington visitation day on....

Thursday, January 14, 2010 10:00 am - 12:00 pm
Saturday, March 6, 2010 10:00 am - 12:00 pm
Thursday, April 22, 2010 7:00 pm - 9:00 pm

Name:

Address:

City:

State:   Zip:

* Email: (Required)

Phone Number:
- -

Name of High School:

Graduation Year:

If parents will accompany you, how many?