UIC Open House Reservation Card

* indicates required fields

Event Date and Time: 9/13/2014 8:00 a.m. - 2:00 p.m.
Event Type: Fall 2014 UIC Open House
Location:UIC Forum, 725 West Roosevelt Road, Chicago, Illinois 60608
Reservation E-mail Address:*
Student Type:*
Legal First Name:*
Legal Middle Name:
Legal Last Name:*
Date of Birth (MM/DD/YYYY):*
Street Address:*
Street Address Line 2:
Street Address Line 3:
(United States and Canadian Provinces only)
ZIP Code:*
Phone Number:*
(Please enter the phone number starting with area code and no spaces.ex:3129969999)
Semester you wish to begin at UIC:
Please select one UIC program that you are interested in learning more about *:
Total number of people who plan to attend this UIC visit (include yourself, family, and friends):*