Alumni

Class Notes & Directory Updates

Please note that address and phone number information is for School of Medicine use only. We will not put your contact information online. Thank you for your time!

Note: As class notes are reviewed for content, your information will not immediately appear in the Class Notes Database.

Graduation Year

Name

Home Address

City

State

Zip Code

Home Phone
(please include
area code)

Email Address

 

Check here to register this email for the
alumni email directory.

Specialty

Practice/Hospital

Street Address

City

State

Zip Code

Business Phone
(please include area code)

Business Fax
(please include
area code)

 

Check here if interested in serving on the
Medical Alumni Association Board.

Tell us about your career, honors, awards, publications, etc...

What kind of alumni outings would you be most interested in attending? Football or baseball games? Picnics?

Would you be interested in helping to organize an event in your area?

Do you have a story idea for Vital Signs? Tell us about it.

What do you value most about your School of Medicine education?

Spouse's Name and Occupation

Personal Highlights


Children's Names and Ages

You may also fill out this form, print it and send a copy to:

Office of Advancement
Boonshoft School of Medicine
3640 Colonel Glenn Highway
Dayton, OH 45435
(937) 245-7610
Fax: (937) 245-7949

Last updated: March 07, 2013