Request Information

Please complete and submit the form below if you wish to be contacted by the MACI program.

I plan to attend the October 19, 2007 open house.

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First Name:

Last Name:

Email:

Phone:

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Example: 6172542233

Address:

City:

Country:

State:

Zip Code:

College/University:

Undergraduate Major:

Year of Application to Graduate School:

List any experience in clinical research (include professional, volunteer, or course work ):

How did you hear about the program?

Choose one

Or please state other source.

If graduate fair, please specify which:

If online, please specify URL:

If any other, please specify:

For more information please email maci@bu.edu or call Linda Zimmerman at 617-638-5704

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